Provider Demographics
NPI:1346612512
Name:ASSISTCARE, INC.
Entity Type:Organization
Organization Name:ASSISTCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PANOME
Authorized Official - Middle Name:
Authorized Official - Last Name:THEPMANIVONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-557-2229
Mailing Address - Street 1:3576 CHAMBLEE TUCKER RD
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-4424
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3576 CHAMBLEE TUCKER RD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341-4424
Practice Address - Country:US
Practice Address - Phone:404-836-1989
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-27
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251E00000XAgenciesHome Health
No251S00000XAgenciesCommunity/Behavioral Health
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child