Healthcare Provider Details

I. General information

NPI: 1790694792
Provider Name (Legal Business Name): COMPANION I CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11720 AMBER PARK DR
ALPHARETTA GA
30009-2275
US

IV. Provider business mailing address

11720 AMBER PARK DR
ALPHARETTA GA
30009-2275
US

V. Phone/Fax

Practice location:
  • Phone: 225-226-2536
  • Fax:
Mailing address:
  • Phone: 225-226-2536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: LACHANDON BURKS
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 225-226-2536