Healthcare Provider Details

I. General information

NPI: 1841597275
Provider Name (Legal Business Name): SHIRLEY'S CAREGIVERS HOME CARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2011
Last Update Date: 02/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 PEACHTREE ST STE 2200
ATLANTA GA
30303-1292
US

IV. Provider business mailing address

260 PEACHTREE ST STE 2200
ATLANTA GA
30303-1292
US

V. Phone/Fax

Practice location:
  • Phone: 770-675-3872
  • Fax: 678-401-2619
Mailing address:
  • Phone: 770-675-3872
  • Fax: 678-401-2619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number13364
License Number StateGA

VIII. Authorized Official

Name: MISS SHIRLEY GLASS
Title or Position: PRESIDENT/CEO
Credential:
Phone: 770-675-3872