Provider Demographics
NPI:1720660616
Name:EPSILON HOME BASED QUALITY CARE, LLC
Entity Type:Organization
Organization Name:EPSILON HOME BASED QUALITY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GLAVDIA
Authorized Official - Middle Name:G
Authorized Official - Last Name:DELVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:516-309-3510
Mailing Address - Street 1:1334 GULFPORT RUN
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:GA
Mailing Address - Zip Code:30017-2949
Mailing Address - Country:US
Mailing Address - Phone:770-824-3940
Mailing Address - Fax:770-415-3008
Practice Address - Street 1:1350 SCENIC HWY N STE 266
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-7924
Practice Address - Country:US
Practice Address - Phone:770-824-3940
Practice Address - Fax:770-415-3008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-21
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care