Provider Demographics
NPI:1891938437
Name:GRASSROOT TENDER CARE
Entity Type:Organization
Organization Name:GRASSROOT TENDER CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:FINE
Authorized Official - Middle Name:
Authorized Official - Last Name:AKANBI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-396-5978
Mailing Address - Street 1:6855 DEER TRAIL LN
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-5496
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6961 PEACHTREE INDUSTRIAL BLVD
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-3647
Practice Address - Country:US
Practice Address - Phone:404-396-5978
Practice Address - Fax:404-601-6059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-13
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA067-R-0550251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health