Healthcare Provider Details

I. General information

NPI: 1881470698
Provider Name (Legal Business Name): MNR HOME CARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2023
Last Update Date: 09/25/2023
Certification Date: 09/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2795 MAIN ST W STE 20A
SNELLVILLE GA
30078-3072
US

IV. Provider business mailing address

PO BOX 390551
SNELLVILLE GA
30039-0010
US

V. Phone/Fax

Practice location:
  • Phone: 470-909-7318
  • Fax: 770-676-7087
Mailing address:
  • Phone: 470-226-1766
  • Fax: 770-676-7087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: NICHOLE RICHARDSON
Title or Position: CEO
Credential:
Phone: 470-909-7318