Provider Demographics
NPI:1609579796
Name:PROBITY TENDER CARE LLC
Entity Type:Organization
Organization Name:PROBITY TENDER CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:
Authorized Official - Last Name:MOMODU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-883-8006
Mailing Address - Street 1:212 EVERGREEN WAY
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-3160
Mailing Address - Country:US
Mailing Address - Phone:404-883-8006
Mailing Address - Fax:
Practice Address - Street 1:212 EVERGREEN WAY
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-3160
Practice Address - Country:US
Practice Address - Phone:404-883-8006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No164X00000XNursing Service ProvidersLicensed Vocational NurseGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty