Provider Demographics
NPI:1891380408
Name:2CBO HOME CARE, LLC
Entity Type:Organization
Organization Name:2CBO HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:RUDDER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:770-649-3933
Mailing Address - Street 1:2262 MERRYMOUNT DR
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-2792
Mailing Address - Country:US
Mailing Address - Phone:770-649-3933
Mailing Address - Fax:
Practice Address - Street 1:833 CAMPBELL HILL ST NW STE 116
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1135
Practice Address - Country:US
Practice Address - Phone:770-649-3933
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-05
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health