Provider Demographics
NPI:1528378718
Name:IDEABANK, LLC
Entity Type:Organization
Organization Name:IDEABANK, LLC
Other - Org Name:VALOR HOME HEALTH, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAMMELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-915-9902
Mailing Address - Street 1:2158 CUMBERLAND PKWY SE
Mailing Address - Street 2:SUITE 8208
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-4539
Mailing Address - Country:US
Mailing Address - Phone:404-915-9902
Mailing Address - Fax:
Practice Address - Street 1:2158 CUMBERLAND PKWY SE
Practice Address - Street 2:SUITE 8208
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-4539
Practice Address - Country:US
Practice Address - Phone:404-915-9902
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-20
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN055058251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health