Healthcare Provider Details

I. General information

NPI: 1922887850
Provider Name (Legal Business Name): HEALTHCARE SUPPORT HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2023
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1372 PEACHTREE ST NE
ATLANTA GA
30309-3203
US

IV. Provider business mailing address

1372 PEACHTREE ST NE
ATLANTA GA
30309-3203
US

V. Phone/Fax

Practice location:
  • Phone: 404-375-7808
  • Fax:
Mailing address:
  • Phone:
  • 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 Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: KENDRA CLOUD
Title or Position: OWNER/ADMINISTRATOR
Credential:
Phone: 404-375-7808