Provider Demographics
NPI:1588844823
Name:CONTACT IN-HOME CARE, LLC
Entity Type:Organization
Organization Name:CONTACT IN-HOME CARE, LLC
Other - Org Name:CONTACT MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AKACHUKWU
Authorized Official - Middle Name:I
Authorized Official - Last Name:ONYILIOGWU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-807-8910
Mailing Address - Street 1:PO BOX 1105
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-1105
Mailing Address - Country:US
Mailing Address - Phone:770-807-8910
Mailing Address - Fax:678-999-5234
Practice Address - Street 1:375 SCENIC HWY
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-5672
Practice Address - Country:US
Practice Address - Phone:770-807-8910
Practice Address - Fax:678-999-5234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-03
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA067-R-0268251E00000X
GA6698820001332B00000X, 332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA692175077DMedicaid