Healthcare Provider Details

I. General information

NPI: 1881356723
Provider Name (Legal Business Name): SWC HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2021
Last Update Date: 10/07/2021
Certification Date: 10/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6862 MABLETON PKWY SE APT 707
MABLETON GA
30126-4596
US

IV. Provider business mailing address

2905 E POINT ST UNIT 90298
ATLANTA GA
30364-8607
US

V. Phone/Fax

Practice location:
  • Phone: 770-714-0618
  • Fax:
Mailing address:
  • Phone: 770-714-0618
  • 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: VANESA D BOGUS
Title or Position: OWNER
Credential:
Phone: 770-714-0618