Provider Demographics
NPI:1598275976
Name:YOUR GEORGIA HOME CARE, LLC
Entity Type:Organization
Organization Name:YOUR GEORGIA HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DUCEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-575-2257
Mailing Address - Street 1:627 OAKBOURNE WAY
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-1859
Mailing Address - Country:US
Mailing Address - Phone:678-575-2257
Mailing Address - Fax:
Practice Address - Street 1:2453 POWDER SPRINGS RD SW STE 220A
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-4570
Practice Address - Country:US
Practice Address - Phone:770-250-1753
Practice Address - Fax:770-250-1726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-11
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherTAX ID