Provider Demographics
NPI:1659998235
Name:RAZOM HEALTHCARE, LLC
Entity Type:Organization
Organization Name:RAZOM HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHIOMA
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:OFFODILE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-429-5597
Mailing Address - Street 1:7803 BAR HARBOR DR
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30296-3370
Mailing Address - Country:US
Mailing Address - Phone:404-429-5597
Mailing Address - Fax:
Practice Address - Street 1:7803 BAR HARBOR DR
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30296-3370
Practice Address - Country:US
Practice Address - Phone:404-429-5597
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-30
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003231233AMedicaid
GA003231233BMedicaid