Healthcare Provider Details

I. General information

NPI: 1760250989
Provider Name (Legal Business Name): SLYCHOK HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2023
Last Update Date: 12/18/2023
Certification Date: 12/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6689 LAKEFIELD FORREST DR
RIVERDALE GA
30296-1975
US

IV. Provider business mailing address

6689 LAKEFIELD FORREST DR
RIVERDALE GA
30296-1975
US

V. Phone/Fax

Practice location:
  • Phone: 404-444-9602
  • Fax:
Mailing address:
  • Phone: 404-444-9602
  • 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 Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: ETHEL UZO NWADIKE
Title or Position: CEO
Credential:
Phone: 404-444-9602