Provider Demographics
NPI:1164819074
Name:INDEPENDENCE HOME HEALTH CARE
Entity Type:Organization
Organization Name:INDEPENDENCE HOME HEALTH CARE
Other - Org Name:INDEPENDENCE HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:J
Authorized Official - Last Name:NESBITT
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, ABD
Authorized Official - Phone:404-454-2461
Mailing Address - Street 1:1103 SUMMIT SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30350-2934
Mailing Address - Country:US
Mailing Address - Phone:404-454-2461
Mailing Address - Fax:
Practice Address - Street 1:1103 SUMMIT SPRINGS DR
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30350-2934
Practice Address - Country:US
Practice Address - Phone:404-454-2461
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-17
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0527290072472R0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2472R0900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherRenal DialysisGroup - Single Specialty