Provider Demographics
NPI:1295359388
Name:SOLIDARITY HOME CARE LLC
Entity Type:Organization
Organization Name:SOLIDARITY HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PHAEDRA
Authorized Official - Middle Name:R
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-707-3979
Mailing Address - Street 1:4670 BALD EAGLE WAY
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-7489
Mailing Address - Country:US
Mailing Address - Phone:470-707-3979
Mailing Address - Fax:
Practice Address - Street 1:4670 BALD EAGLE WAY
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-7489
Practice Address - Country:US
Practice Address - Phone:470-707-3979
Practice Address - Fax:678-503-2021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-03
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003247233AMedicaid
GA1295359388Medicaid