Healthcare Provider Details

I. General information

NPI: 1669272704
Provider Name (Legal Business Name): JDH HOME HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2025
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

434 MATTHEWS RD
TENNILLE GA
31089-4120
US

IV. Provider business mailing address

434 MATTHEWS RD
TENNILLE GA
31089-4120
US

V. Phone/Fax

Practice location:
  • Phone: 478-232-0187
  • Fax: 478-232-0187
Mailing address:
  • Phone: 478-232-0187
  • Fax: 478-232-0187

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
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MS. AMBRIELLE RASHONDA JANIQUE HAGANS
Title or Position: CERTIFIED PHARMACY TECHNICIAN
Credential: PHARMACY TECHNICIAN
Phone: 478-232-0187