Healthcare Provider Details

I. General information

NPI: 1356603658
Provider Name (Legal Business Name): FAMILY PRIVATE CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2012
Last Update Date: 06/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6065 LAKE FORREST DR NW SUITE 170
SANDY SPRINGS GA
30328-3850
US

IV. Provider business mailing address

6065 LAKE FORREST DR NW SUITE 170
SANDY SPRINGS GA
30328-3850
US

V. Phone/Fax

Practice location:
  • Phone: 404-252-9005
  • Fax: 404-252-9035
Mailing address:
  • Phone: 404-252-9005
  • Fax: 404-252-9035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number060-R-0138
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number060-R-0138
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number060-R-0138
License Number StateGA

VIII. Authorized Official

Name: TONY PLUMMER
Title or Position: CEO
Credential:
Phone: 404-252-9005