Provider Demographics
NPI:1497140099
Name:HANDS ON COMPANION AGENCY
Entity Type:Organization
Organization Name:HANDS ON COMPANION AGENCY
Other - Org Name:TENIKA DAVENPORT
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:TENIKA
Authorized Official - Middle Name:NECOLE
Authorized Official - Last Name:DAVENPORT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-200-3851
Mailing Address - Street 1:4972 MCNAIR RD
Mailing Address - Street 2:P O BOX 1102
Mailing Address - City:CAMILLA
Mailing Address - State:GA
Mailing Address - Zip Code:31730-3942
Mailing Address - Country:US
Mailing Address - Phone:229-200-3851
Mailing Address - Fax:
Practice Address - Street 1:4972 MCNAIR RD
Practice Address - Street 2:
Practice Address - City:CAMILLA
Practice Address - State:GA
Practice Address - Zip Code:31730-3942
Practice Address - Country:US
Practice Address - Phone:229-200-3851
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-31
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA101R1381251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA260476814Medicaid