Provider Demographics
NPI:1255752408
Name:HISGRIP LLC
Entity type:Organization
Organization Name:HISGRIP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:OMONIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:AREMU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-753-6021
Mailing Address - Street 1:2475 NORTHWINDS PKWY
Mailing Address - Street 2:STE 200
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-4807
Mailing Address - Country:US
Mailing Address - Phone:770-753-6021
Mailing Address - Fax:770-476-2107
Practice Address - Street 1:2475 NORTHWINDS PKWY
Practice Address - Street 2:STE 200
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-4807
Practice Address - Country:US
Practice Address - Phone:770-753-6021
Practice Address - Fax:770-476-2107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-13
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA060-R-0366253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA663606744AMedicaid