Provider Demographics
NPI:1689448458
Name:MOMENTS HOME CARE OF GEORGIA, LLC
Entity Type:Organization
Organization Name:MOMENTS HOME CARE OF GEORGIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:STEFANO
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-983-6016
Mailing Address - Street 1:430 IVEY EDWARDS LN
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-5407
Mailing Address - Country:US
Mailing Address - Phone:631-452-7327
Mailing Address - Fax:
Practice Address - Street 1:430 IVEY EDWARDS LN
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-5407
Practice Address - Country:US
Practice Address - Phone:631-452-7327
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care