Healthcare Provider Details

I. General information

NPI: 1750866232
Provider Name (Legal Business Name): NKY HOUSING AND HOMECARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2018
Last Update Date: 10/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4854 OLD NATIONAL HWY STE 275
COLLEGE PARK GA
30337-6242
US

IV. Provider business mailing address

1856 WATERCREST DR
JONESBORO GA
30236-8031
US

V. Phone/Fax

Practice location:
  • Phone: 404-663-2493
  • Fax:
Mailing address:
  • Phone: 404-663-2493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: MS. RUBY N. NNADI
Title or Position: OWNER
Credential:
Phone: 404-663-2493