Provider Demographics
NPI:1518385673
Name:JUSTIN HOMECARE SERVICES, INC
Entity Type:Organization
Organization Name:JUSTIN HOMECARE SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OPERATIONS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:UGONNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-578-0379
Mailing Address - Street 1:522 N MAIN ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CEDARTOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30125-2372
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:522 N MAIN ST
Practice Address - Street 2:SUITE 104
Practice Address - City:CEDARTOWN
Practice Address - State:GA
Practice Address - Zip Code:30125-2372
Practice Address - Country:US
Practice Address - Phone:404-578-0379
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-04
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA115-R-1095251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health