Provider Demographics
NPI:1437679339
Name:MEDIATOR SENIOR CARE, LLC
Entity Type:Organization
Organization Name:MEDIATOR SENIOR CARE, LLC
Other - Org Name:HOME INSTEAD SENIOR CARE #788
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:BARLOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-922-3601
Mailing Address - Street 1:4143 COLUMBIA RD STE B
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-5405
Mailing Address - Country:US
Mailing Address - Phone:706-922-3601
Mailing Address - Fax:706-922-3608
Practice Address - Street 1:4143 COLUMBIA RD.
Practice Address - Street 2:SUITE B
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907
Practice Address - Country:US
Practice Address - Phone:706-922-3601
Practice Address - Fax:706-922-3608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA036-R-1348253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care