Provider Demographics
NPI:1609246586
Name:MID GEORGIA HOME CARE, LLC
Entity Type:Organization
Organization Name:MID GEORGIA HOME CARE, LLC
Other - Org Name:GRISWOLD HOME CARE COVINGTON-GREENSBORO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:KIDD
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-731-6061
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30015-0309
Mailing Address - Country:US
Mailing Address - Phone:706-383-7779
Mailing Address - Fax:470-444-1790
Practice Address - Street 1:10277 INDUSTRIAL BLVD
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-1485
Practice Address - Country:US
Practice Address - Phone:706-383-7779
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-05
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA117-R-1268251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health