Healthcare Provider Details

I. General information

NPI: 1295359388
Provider Name (Legal Business Name): SOLIDARITY HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2020
Last Update Date: 05/20/2021
Certification Date: 05/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4670 BALD EAGLE WAY
DOUGLASVILLE GA
30135-7489
US

IV. Provider business mailing address

4670 BALD EAGLE WAY
DOUGLASVILLE GA
30135-7489
US

V. Phone/Fax

Practice location:
  • Phone: 470-707-3979
  • Fax: 678-503-2021
Mailing address:
  • Phone: 470-707-3979
  • 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 Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: PHAEDRA R BROWN
Title or Position: OWNER/MANAGER
Credential:
Phone: 470-707-3979