Provider Demographics
NPI:1740778463
Name:IMMACULATE HEALTHCARE SOLUTIONS, LLC
Entity Type:Organization
Organization Name:IMMACULATE HEALTHCARE SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:IJEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-944-9516
Mailing Address - Street 1:970 PEACHTREE INDUSTRIAL BLVD STE 8
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6988
Mailing Address - Country:US
Mailing Address - Phone:678-707-2369
Mailing Address - Fax:
Practice Address - Street 1:970 PEACHTREE INDUSTRIAL BLVD STE 8
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024
Practice Address - Country:US
Practice Address - Phone:404-944-9516
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-27
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health