Healthcare Provider Details

I. General information

NPI: 1073997334
Provider Name (Legal Business Name): PRIMROSE HOME CARE & STAFFING SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2015
Last Update Date: 07/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4525 FLAT SHOALS PKWY STE 401
DECATUR GA
30034-5038
US

IV. Provider business mailing address

4525 FLAT SHOALS PKWY STE 401
DECATUR GA
30034-5038
US

V. Phone/Fax

Practice location:
  • Phone: 404-600-8675
  • Fax:
Mailing address:
  • Phone: 404-600-8675
  • 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 Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ERNEST FLAGG
Title or Position: ADMINISTRATOR
Credential:
Phone: 404-600-8675