Healthcare Provider Details

I. General information

NPI: 1851078521
Provider Name (Legal Business Name): RELIANCE PRIVATE HOMECARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2023
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2668 WESTCHESTER PKWY SE
CONYERS GA
30013-2400
US

IV. Provider business mailing address

2668 WESTCHESTER PKWY SE
CONYERS GA
30013-2400
US

V. Phone/Fax

Practice location:
  • Phone: 678-520-1470
  • Fax:
Mailing address:
  • Phone: 678-520-1470
  • 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 Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. CHARMANTE CYRIUS
Title or Position: OWNER/ADMINISTRATOR
Credential: NP, RN
Phone: 678-520-1470