Healthcare Provider Details

I. General information

NPI: 1093645475
Provider Name (Legal Business Name): GIDIANA HOME CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

771 RALPH STILL RD
DACULA GA
30019-2816
US

IV. Provider business mailing address

771 RALPH STILL RD
DACULA GA
30019-2816
US

V. Phone/Fax

Practice location:
  • Phone: 470-469-1168
  • Fax: 470-995-2808
Mailing address:
  • Phone: 470-469-1168
  • Fax: 470-995-2808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: JACOB PREMPEH
Title or Position: ADMINISTRATOR
Credential: ADMINISTRATOR
Phone: 470-469-1168