Provider Demographics
NPI:1992370571
Name:JUMPSTART HEALTHCARE SERVICES LLC
Entity Type:Organization
Organization Name:JUMPSTART HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICHOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-499-1102
Mailing Address - Street 1:3350 MILLERS POND WAY SW
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039
Mailing Address - Country:US
Mailing Address - Phone:678-499-1102
Mailing Address - Fax:678-882-3825
Practice Address - Street 1:4153C FLAT SHOALS PKWY STE 324D
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-4863
Practice Address - Country:US
Practice Address - Phone:678-499-1102
Practice Address - Fax:678-882-3825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000000000Other0000000