Provider Demographics
NPI:1477241859
Name:KING HOME CARE LLC
Entity Type:Organization
Organization Name:KING HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARSLEISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:KING DEJESUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-850-6548
Mailing Address - Street 1:302 ERMINES WAY
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-1904
Mailing Address - Country:US
Mailing Address - Phone:404-850-6548
Mailing Address - Fax:
Practice Address - Street 1:302 ERMINES WAY
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-1904
Practice Address - Country:US
Practice Address - Phone:404-850-6548
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-25
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care