Provider Demographics
NPI:1225890742
Name:CAPITOL HOME CARE SERVICES OF GEORGIA LLC
Entity Type:Organization
Organization Name:CAPITOL HOME CARE SERVICES OF GEORGIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:GLYNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:LEFLORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-769-2464
Mailing Address - Street 1:4480 S COBB DR SE STE H-477
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-6990
Mailing Address - Country:US
Mailing Address - Phone:404-769-2464
Mailing Address - Fax:
Practice Address - Street 1:4745 LEGACY COVE LN
Practice Address - Street 2:
Practice Address - City:MABLETON
Practice Address - State:GA
Practice Address - Zip Code:30126-2580
Practice Address - Country:US
Practice Address - Phone:404-769-2464
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No251B00000XAgenciesCase Management
No251J00000XAgenciesNursing Care
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QM1102XAmbulatory Health Care FacilitiesClinic/CenterMilitary Outpatient Operational (Transportable) Component
No261QM3000XAmbulatory Health Care FacilitiesClinic/CenterMedically Fragile Infants and Children Day Care
No261QP2400XAmbulatory Health Care FacilitiesClinic/CenterPrison Health
No261QV0200XAmbulatory Health Care FacilitiesClinic/CenterVA
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332S00000XSuppliersHearing Aid Equipment
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No385H00000XRespite Care FacilityRespite Care