Provider Demographics
NPI:1609634815
Name:GEORGIA HOME CARE SERVICES LLC
Entity Type:Organization
Organization Name:GEORGIA HOME CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AHMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAKENEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-201-8038
Mailing Address - Street 1:4401 E INDEPENDENCE BLVD STE 200D
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-7485
Mailing Address - Country:US
Mailing Address - Phone:704-275-3312
Mailing Address - Fax:
Practice Address - Street 1:1300 JOSEPH E BOONE BLVD NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30314-2032
Practice Address - Country:US
Practice Address - Phone:404-939-9965
Practice Address - Fax:404-420-2250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health