Provider Demographics
NPI:1477199867
Name:1ST SENIOR CARES, LLC
Entity Type:Organization
Organization Name:1ST SENIOR CARES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-359-6545
Mailing Address - Street 1:7116 PEACHTREE INDUSTRIAL BLVD. BLDG. 4, STE. B
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CORNERS
Mailing Address - State:GA
Mailing Address - Zip Code:30071
Mailing Address - Country:US
Mailing Address - Phone:678-359-6545
Mailing Address - Fax:678-889-5399
Practice Address - Street 1:7116 PEACHTREE INDUSTRIAL BLVD. BLDG. 4, STE. B
Practice Address - Street 2:
Practice Address - City:PEACHTREE CORNERS
Practice Address - State:GA
Practice Address - Zip Code:30071
Practice Address - Country:US
Practice Address - Phone:678-359-6545
Practice Address - Fax:678-889-5399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-21
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003108488DMedicaid