Provider Demographics
NPI:1881805505
Name:JUSTICE HOME CARE INC
Entity type:Organization
Organization Name:JUSTICE HOME CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:478-746-9988
Mailing Address - Street 1:PO BOX 2092
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-8908
Mailing Address - Country:US
Mailing Address - Phone:478-746-9988
Mailing Address - Fax:478-746-5111
Practice Address - Street 1:2733 SHERATON DR
Practice Address - Street 2:SUITE 165
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204-6826
Practice Address - Country:US
Practice Address - Phone:478-746-9988
Practice Address - Fax:478-746-5111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA011R0034251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00437577BMedicaid