Healthcare Provider Details

I. General information

NPI: 1538791413
Provider Name (Legal Business Name): LEAGUE OF PRIVATE HOMECARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2020
Last Update Date: 02/07/2020
Certification Date: 02/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5310 ARBOR GATES DR NE
ATLANTA GA
30324-5619
US

IV. Provider business mailing address

5310 ARBOR GATES DR NE
ATLANTA GA
30324-5619
US

V. Phone/Fax

Practice location:
  • Phone: 470-377-1829
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH WALTER BRADLEY II
Title or Position: ADMINISTRATOR
Credential:
Phone: 470-377-1829