Healthcare Provider Details

I. General information

NPI: 1548187131
Provider Name (Legal Business Name): I.T.A HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 MEADOWRIDGE DR
COVINGTON GA
30016-1871
US

IV. Provider business mailing address

125 MEADOWRIDGE DR
COVINGTON GA
30016-1871
US

V. Phone/Fax

Practice location:
  • Phone: 706-319-0110
  • Fax:
Mailing address:
  • Phone: 706-319-0110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: NEISHA-KAY SAMANTHA MCKENZIE
Title or Position: OWNER/ADMINISTRATOR
Credential: BSN,RN
Phone: 470-554-0730