Provider Demographics
NPI:1134568611
Name:GODS APPOINTED TIME PRIVATE HOMECARE
Entity type:Organization
Organization Name:GODS APPOINTED TIME PRIVATE HOMECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:KENYA
Authorized Official - Middle Name:YOLONDA
Authorized Official - Last Name:JONES
Authorized Official - Suffix:II
Authorized Official - Credentials:MESICAL ASSISTANT
Authorized Official - Phone:404-707-0527
Mailing Address - Street 1:2625 CHARLESTOWN DR
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30337-3943
Mailing Address - Country:US
Mailing Address - Phone:404-707-0527
Mailing Address - Fax:
Practice Address - Street 1:2625 CHARLESTOWN DR
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30337-3943
Practice Address - Country:US
Practice Address - Phone:404-707-0527
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-18
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA060-R1066251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health