Provider Demographics
NPI:1013290436
Name:LIVING PRIVATE HOME CARE
Entity Type:Organization
Organization Name:LIVING PRIVATE HOME CARE
Other - Org Name:N/A
Other - Org Type:Other Name
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NNENNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:EKEKE
Authorized Official - Suffix:
Authorized Official - Credentials:N/A
Authorized Official - Phone:404-518-0619
Mailing Address - Street 1:3034 GRAND AVE SW
Mailing Address - Street 2:N/A
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30315-9020
Mailing Address - Country:US
Mailing Address - Phone:404-518-0619
Mailing Address - Fax:770-969-0694
Practice Address - Street 1:3034 GRAND AVE SW
Practice Address - Street 2:N/A
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30315-9020
Practice Address - Country:US
Practice Address - Phone:404-518-0619
Practice Address - Fax:770-964-0694
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:N/A
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0060R0065385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care