Provider Demographics
NPI:1619339793
Name:JACK REDMOND HOME CARE INC.
Entity Type:Organization
Organization Name:JACK REDMOND HOME CARE INC.
Other - Org Name:GRISWOLD HOME CARE ATLANTA NW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:HARRIS
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-427-8606
Mailing Address - Street 1:1000 WHITLOCK AVE NW STE 320
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-5449
Mailing Address - Country:US
Mailing Address - Phone:770-427-8606
Mailing Address - Fax:770-427-7207
Practice Address - Street 1:1000 WHITLOCK AVE NW STE 320
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-5449
Practice Address - Country:US
Practice Address - Phone:770-427-8606
Practice Address - Fax:770-427-7207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-28
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033-R-0048253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care