Healthcare Provider Details

I. General information

NPI: 1164178737
Provider Name (Legal Business Name): BDR HOME CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2022
Last Update Date: 02/23/2022
Certification Date: 02/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2262 MERRYMOUNT DR
SUWANEE GA
30024-2792
US

IV. Provider business mailing address

2262 MERRYMOUNT DR
SUWANEE GA
30024-2792
US

V. Phone/Fax

Practice location:
  • Phone: 770-649-3933
  • Fax:
Mailing address:
  • Phone: 770-649-3933
  • 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 Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: TERESA E RUDDER
Title or Position: OWNER
Credential: RN
Phone: 770-649-3933