Provider Demographics
NPI:1598001075
Name:KOSTA PRIVATE HOME CARE, LLC
Entity Type:Organization
Organization Name:KOSTA PRIVATE HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNASKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-814-3092
Mailing Address - Street 1:235 PEACHTREE ST NE STE 400
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30303-1400
Mailing Address - Country:US
Mailing Address - Phone:404-814-3092
Mailing Address - Fax:888-608-5705
Practice Address - Street 1:235 PEACHTREE ST NE STE 400
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-1400
Practice Address - Country:US
Practice Address - Phone:404-814-3092
Practice Address - Fax:888-608-5705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-02
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA060-R-1088251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health