Healthcare Provider Details

I. General information

NPI: 1619708427
Provider Name (Legal Business Name): BRIKADA CARES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2024
Last Update Date: 08/13/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 CAMELLIA WAY
DALLAS GA
30132-5522
US

IV. Provider business mailing address

108 CAMELLIA WAY
DALLAS GA
30132-5522
US

V. Phone/Fax

Practice location:
  • Phone: 404-514-8879
  • Fax:
Mailing address:
  • Phone: 404-514-8879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: SHEM ANDREW MOBISA
Title or Position: OWNER
Credential: RN
Phone: 404-514-8879