Provider Demographics
NPI:1568775286
Name:HOME 4 OUR LOVE ONES, INC.
Entity Type:Organization
Organization Name:HOME 4 OUR LOVE ONES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:HAMPTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-421-1684
Mailing Address - Street 1:2221 STERLING RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032-6152
Mailing Address - Country:US
Mailing Address - Phone:404-421-1684
Mailing Address - Fax:404-534-6635
Practice Address - Street 1:2221 STERLING RIDGE RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-6152
Practice Address - Country:US
Practice Address - Phone:404-421-1684
Practice Address - Fax:404-534-6635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-22
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044018181251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA330756300AMedicaid