Provider Demographics
NPI:1417657552
Name:SHELTER AT HOME CARE LLC
Entity Type:Organization
Organization Name:SHELTER AT HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:INGRAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-447-1971
Mailing Address - Street 1:6800 BELLS LANDING WAY
Mailing Address - Street 2:
Mailing Address - City:REX
Mailing Address - State:GA
Mailing Address - Zip Code:30273-2242
Mailing Address - Country:US
Mailing Address - Phone:478-447-1971
Mailing Address - Fax:
Practice Address - Street 1:409 ARROWHEAD BLVD STE A138
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-1260
Practice Address - Country:US
Practice Address - Phone:478-447-1971
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPHCP011252OtherPHCP