Provider Demographics
NPI:1467277285
Name:RESIDE WELL, LLC
Entity type:Organization
Organization Name:RESIDE WELL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:C
Authorized Official - Last Name:BOHANON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-925-4621
Mailing Address - Street 1:6130 WINDFLOWER DR
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-8321
Mailing Address - Country:US
Mailing Address - Phone:678-925-4621
Mailing Address - Fax:
Practice Address - Street 1:4255 WADE GREEN RD NW STE 210
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-1810
Practice Address - Country:US
Practice Address - Phone:678-925-4621
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care