Healthcare Provider Details

I. General information

NPI: 1003348707
Provider Name (Legal Business Name): JENESYS HOME CARE ATLANTA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2017
Last Update Date: 03/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3464 ROXBORO RD NE UNIT 1110
ATLANTA GA
30326-1317
US

IV. Provider business mailing address

1403 GREENBRIER PKWY STE 100
CHESAPEAKE VA
23320-2876
US

V. Phone/Fax

Practice location:
  • Phone: 757-419-6153
  • Fax: 757-420-0599
Mailing address:
  • Phone: 757-420-0566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: SHANTE HALL
Title or Position: CEO
Credential:
Phone: 757-420-0566