Provider Demographics
NPI:1851066740
Name:ABODE INDEPENDENCE HOME CARE LLC.
Entity Type:Organization
Organization Name:ABODE INDEPENDENCE HOME CARE LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TIEARA
Authorized Official - Middle Name:DIJON
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:770-203-6660
Mailing Address - Street 1:140 AL JENNAH BLVD
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:GA
Mailing Address - Zip Code:30248-3753
Mailing Address - Country:US
Mailing Address - Phone:770-927-8119
Mailing Address - Fax:
Practice Address - Street 1:140 AL JENNAH BLVD
Practice Address - Street 2:
Practice Address - City:LOCUST GROVE
Practice Address - State:GA
Practice Address - Zip Code:30248-3753
Practice Address - Country:US
Practice Address - Phone:770-927-8119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care