Provider Demographics
NPI:1922292853
Name:DIRECT HEALTHCARE & SUPPLIES SERVICE, LLC
Entity Type:Organization
Organization Name:DIRECT HEALTHCARE & SUPPLIES SERVICE, LLC
Other - Org Name:DIRECT HOME CARE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGISTER NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:U
Authorized Official - Last Name:ANYAORAH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:770-831-7758
Mailing Address - Street 1:1362 NICHOLSON PL
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-8301
Mailing Address - Country:US
Mailing Address - Phone:770-831-7758
Mailing Address - Fax:
Practice Address - Street 1:3429 LAWRENCEVILLE
Practice Address - Street 2:BLG 1000 SUITE A
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024
Practice Address - Country:US
Practice Address - Phone:770-831-7758
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health