Provider Demographics
NPI:1750039798
Name:DASOM HOMECARE AGENCY LLC
Entity Type:Organization
Organization Name:DASOM HOMECARE AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:BOGO
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-572-8707
Mailing Address - Street 1:3230 STEVE REYNOLDS BOULEVARD
Mailing Address - Street 2:STE 214
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-8833
Mailing Address - Country:US
Mailing Address - Phone:470-282-1966
Mailing Address - Fax:888-342-1617
Practice Address - Street 1:1238 FORT MARCY PARK
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-3489
Practice Address - Country:US
Practice Address - Phone:678-925-7370
Practice Address - Fax:888-342-1617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-17
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health