Provider Demographics
NPI:1407212012
Name:SHIRLEY & NAOMI PRIVATE HOME CARE SERVICES & TRANSPORTATION
Entity Type:Organization
Organization Name:SHIRLEY & NAOMI PRIVATE HOME CARE SERVICES & TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:CHERRYL
Authorized Official - Last Name:PARRIS-LEUNG
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:404-226-8541
Mailing Address - Street 1:3723 ARMINTO DR
Mailing Address - Street 2:
Mailing Address - City:ELLENWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30294-6663
Mailing Address - Country:US
Mailing Address - Phone:404-226-8541
Mailing Address - Fax:770-389-8554
Practice Address - Street 1:3723 ARMINTO DR
Practice Address - Street 2:
Practice Address - City:ELLENWOOD
Practice Address - State:GA
Practice Address - Zip Code:30294-6663
Practice Address - Country:US
Practice Address - Phone:404-226-8541
Practice Address - Fax:770-389-8554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-12
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA031-R-1524253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care