Healthcare Provider Details

I. General information

NPI: 1669141404
Provider Name (Legal Business Name): ALLY HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2021
Last Update Date: 09/07/2021
Certification Date: 09/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

422 N INDIAN CREEK DR STE D
CLARKSTON GA
30021-2382
US

IV. Provider business mailing address

422 N INDIAN CREEK DR STE D
CLARKSTON GA
30021-2382
US

V. Phone/Fax

Practice location:
  • Phone: 404-910-6174
  • Fax: 404-745-8884
Mailing address:
  • Phone: 404-910-6174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: EDIL JAMA
Title or Position: ADMINISTRATOR
Credential:
Phone: 404-910-6174