Provider Demographics
NPI:1598214181
Name:A&C PRIVATE HOME CARE, LLC
Entity Type:Organization
Organization Name:A&C PRIVATE HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:C
Authorized Official - Last Name:AGWUNOB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-776-6637
Mailing Address - Street 1:4855 IVY RIDGE DR SE
Mailing Address - Street 2:UNIT 405
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-1367
Mailing Address - Country:US
Mailing Address - Phone:770-776-6637
Mailing Address - Fax:
Practice Address - Street 1:4855 IVY RIDGE DR SE
Practice Address - Street 2:UNIT 405
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-1367
Practice Address - Country:US
Practice Address - Phone:770-776-6637
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-24
Last Update Date:2016-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033-R-1499253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care