Provider Demographics
NPI:1790544500
Name:6619 HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:6619 HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:601-365-9384
Mailing Address - Street 1:1730 DEER RUN DR SW
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-4702
Mailing Address - Country:US
Mailing Address - Phone:601-365-9384
Mailing Address - Fax:
Practice Address - Street 1:1730 DEER RUN DR SW
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094-4702
Practice Address - Country:US
Practice Address - Phone:601-365-9384
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-14
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health