Provider Demographics
NPI:1164944799
Name:MAJESTIC OAKS HOME CARE AGENCY LLC
Entity Type:Organization
Organization Name:MAJESTIC OAKS HOME CARE AGENCY LLC
Other - Org Name:MAJESTIC OAKS HOME CARE AGENCY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JARRETT
Authorized Official - Middle Name:R
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-256-8513
Mailing Address - Street 1:1000 CORPORATE POINTE STE 307
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-3437
Mailing Address - Country:US
Mailing Address - Phone:478-256-8513
Mailing Address - Fax:
Practice Address - Street 1:1000 CORPORATE POINTE STE 307
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-3437
Practice Address - Country:US
Practice Address - Phone:478-256-8513
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA076-R-1828163W00000X, 164W00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive Care
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty