Provider Demographics
NPI:1750773990
Name:AMADI HOME CARE INC
Entity type:Organization
Organization Name:AMADI HOME CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHERLONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ENAGBARE
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:470-268-6258
Mailing Address - Street 1:4047 HOLCOMB BRIDGE RD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-1842
Mailing Address - Country:US
Mailing Address - Phone:470-268-6258
Mailing Address - Fax:470-375-8801
Practice Address - Street 1:4047 HOLCOMB BRIDGE RD
Practice Address - Street 2:SUITE 230
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-1842
Practice Address - Country:US
Practice Address - Phone:470-268-6258
Practice Address - Fax:470-375-8801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-25
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA067-R-1369253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care