Provider Demographics
NPI:1780184531
Name:DOMINION PARTNERS HOME CARE OF ATLANTA LLC
Entity Type:Organization
Organization Name:DOMINION PARTNERS HOME CARE OF ATLANTA LLC
Other - Org Name:COMFORCARE HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:ACKER
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:770-649-9930
Mailing Address - Street 1:6065 ROSWELL RD STE 424
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-4014
Mailing Address - Country:US
Mailing Address - Phone:770-649-9930
Mailing Address - Fax:770-645-8161
Practice Address - Street 1:6065 ROSWELL RD STE 424
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-4014
Practice Address - Country:US
Practice Address - Phone:770-649-9930
Practice Address - Fax:770-645-8161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-19
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033-R-0083253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA192461923Medicaid