Provider Demographics
NPI:1457840167
Name:HOME CARE SERVICES OF NORTHEAST GEORGIA, INC.
Entity Type:Organization
Organization Name:HOME CARE SERVICES OF NORTHEAST GEORGIA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:KIMMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-481-4829
Mailing Address - Street 1:7433 SPOUT SPRINGS RD STE 101-56
Mailing Address - Street 2:
Mailing Address - City:FLOWERY BRANCH
Mailing Address - State:GA
Mailing Address - Zip Code:30542-7766
Mailing Address - Country:US
Mailing Address - Phone:404-550-2916
Mailing Address - Fax:
Practice Address - Street 1:6105 STILLWATER TRL
Practice Address - Street 2:
Practice Address - City:FLOWERY BRANCH
Practice Address - State:GA
Practice Address - Zip Code:30542-5363
Practice Address - Country:US
Practice Address - Phone:404-550-2916
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-08
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA20262268433OtherSTATE TAX ID