Provider Demographics
NPI:1285036160
Name:PILLAR OF GOD HOMECARE INC
Entity Type:Organization
Organization Name:PILLAR OF GOD HOMECARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:U
Authorized Official - Last Name:ODOEMENE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-744-8291
Mailing Address - Street 1:3538 QUIET CREEK CT SW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-7524
Mailing Address - Country:US
Mailing Address - Phone:770-744-8291
Mailing Address - Fax:
Practice Address - Street 1:2612 AUSTELL RD SW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30008-4544
Practice Address - Country:US
Practice Address - Phone:770-744-8291
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-22
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033R1137251E00000X
GA033-R-1137251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health