Provider Demographics
NPI:1396178711
Name:ATLANTA AREA HOME CARE, LLC
Entity Type:Organization
Organization Name:ATLANTA AREA HOME CARE, LLC
Other - Org Name:TRUSTED SOURCE HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SUTHERLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-609-6477
Mailing Address - Street 1:8302 DUNWOODY PL
Mailing Address - Street 2:SUITE 332
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30350-3317
Mailing Address - Country:US
Mailing Address - Phone:770-609-6477
Mailing Address - Fax:770-686-3653
Practice Address - Street 1:8302 DUNWOODY PL
Practice Address - Street 2:SUITE 332
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30350-3317
Practice Address - Country:US
Practice Address - Phone:770-609-6477
Practice Address - Fax:770-686-3653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA060-R-0971253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care