Healthcare Provider Details

I. General information

NPI: 1194393371
Provider Name (Legal Business Name): LOIS COMFORT HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2021
Last Update Date: 06/15/2021
Certification Date: 06/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3935 OAK PARK DR
SUWANEE GA
30024-1845
US

IV. Provider business mailing address

3935 OAK PARK DR
SUWANEE GA
30024-1845
US

V. Phone/Fax

Practice location:
  • Phone: 470-685-1034
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: ADERINOLA ADEWUMI
Title or Position: OWNER
Credential:
Phone: 470-685-1034