Healthcare Provider Details

I. General information

NPI: 1447174735
Provider Name (Legal Business Name): ROUNDDA KLOCK HOME CARE SERVICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3011 RAINBOW DR STE 114B
DECATUR GA
30034-1852
US

IV. Provider business mailing address

3011 RAINBOW DR STE 114B
DECATUR GA
30034-1852
US

V. Phone/Fax

Practice location:
  • Phone: 943-253-1666
  • Fax:
Mailing address:
  • Phone: 943-253-1666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MOAKINA SHAHON CUNNINGHAM
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 943-253-1666