Provider Demographics
NPI:1912256629
Name:CARE SERVICES AT HOME
Entity Type:Organization
Organization Name:CARE SERVICES AT HOME
Other - Org Name:LONE SHEPHERD HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHACHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-246-4935
Mailing Address - Street 1:165 W WIEUCA RD NE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-3252
Mailing Address - Country:US
Mailing Address - Phone:404-246-4935
Mailing Address - Fax:
Practice Address - Street 1:165 W WIEUCA RD NE
Practice Address - Street 2:SUITE 303
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-3252
Practice Address - Country:US
Practice Address - Phone:404-246-4935
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-10
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA305S00000X, 347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
No347C00000XTransportation ServicesPrivate Vehicle