Healthcare Provider Details

I. General information

NPI: 1063794154
Provider Name (Legal Business Name): BISOL HOME CARE SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2011
Last Update Date: 12/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2759 MOUNT ZION PKWY SUITE D
JONESBORO GA
30236-2568
US

IV. Provider business mailing address

1234 JULIE CT
RIVERDALE GA
30296-2254
US

V. Phone/Fax

Practice location:
  • Phone: 404-285-7276
  • Fax:
Mailing address:
  • Phone: 404-285-7276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number031-R-0745
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number031-R-0745
License Number StateGA

VIII. Authorized Official

Name: MRS. ADEBISI O ADEWAKUN
Title or Position: ADMINISTRATOR
Credential:
Phone: 404-285-7276