Provider Demographics
NPI:1619351970
Name:HOME HEALTH CARE SERVICES LLC
Entity Type:Organization
Organization Name:HOME HEALTH CARE SERVICES LLC
Other - Org Name:HEALTH AT HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:W
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-855-5533
Mailing Address - Street 1:PO BOX 200
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30903-0200
Mailing Address - Country:US
Mailing Address - Phone:706-855-5533
Mailing Address - Fax:706-854-7382
Practice Address - Street 1:14585 59TH AVE N.
Practice Address - Street 2:STE H224
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55446-3872
Practice Address - Country:US
Practice Address - Phone:763-744-9499
Practice Address - Fax:763-744-9439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN371968251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN371968OtherLICENSE
MN371968OtherLICENSE