Provider Demographics
NPI:1457050387
Name:ST ALIZABETH PRIMARY HOMECARE LLC
Entity Type:Organization
Organization Name:ST ALIZABETH PRIMARY HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:OGLESBY
Authorized Official - Suffix:JR
Authorized Official - Credentials:CEO
Authorized Official - Phone:478-420-2307
Mailing Address - Street 1:1707 ZACHARYS WAY
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-9026
Mailing Address - Country:US
Mailing Address - Phone:478-420-2307
Mailing Address - Fax:
Practice Address - Street 1:1707 ZACHARYS WAY
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-9026
Practice Address - Country:US
Practice Address - Phone:478-420-2307
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-28
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care