Healthcare Provider Details

I. General information

NPI: 1376772780
Provider Name (Legal Business Name): HOMECARE HUMAN RESOURCE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2009
Last Update Date: 07/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 PECAN LN
OXFORD GA
30054-3863
US

IV. Provider business mailing address

85 PECAN LN
OXFORD GA
30054-3863
US

V. Phone/Fax

Practice location:
  • Phone: 404-441-6625
  • Fax: 678-342-8575
Mailing address:
  • Phone: 404-441-6625
  • Fax: 678-342-8575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number107-R-0539
License Number StateGA

VIII. Authorized Official

Name: LASHAINNA SADE BAKER
Title or Position: OWNER
Credential:
Phone: 404-441-6625