Provider Demographics
NPI:1508611039
Name:MIG HOME CARE
Entity Type:Organization
Organization Name:MIG HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:OLAYEMI
Authorized Official - Middle Name:
Authorized Official - Last Name:AYETIGBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-287-8053
Mailing Address - Street 1:1875 LOGAN RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-8170
Mailing Address - Country:US
Mailing Address - Phone:404-287-8053
Mailing Address - Fax:
Practice Address - Street 1:1875 LOGAN RIDGE CIR
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-8170
Practice Address - Country:US
Practice Address - Phone:404-287-8053
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home