Healthcare Provider Details

I. General information

NPI: 1699943936
Provider Name (Legal Business Name): FIRST OPPORTUNITY HOME HEALTHCARE,LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2008
Last Update Date: 10/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3113 CALIENTE LN
REX GA
30273-1002
US

IV. Provider business mailing address

3113 CALIENTE LN
REX GA
30273-1002
US

V. Phone/Fax

Practice location:
  • Phone: 678-422-4940
  • Fax: 678-422-4940
Mailing address:
  • Phone: 678-422-4940
  • Fax: 678-422-4940

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: MISS KENDRA BARDARA OUTRAM
Title or Position: CEO
Credential:
Phone: 678-422-4940