Healthcare Provider Details

I. General information

NPI: 1659026599
Provider Name (Legal Business Name): MSK HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2022
Last Update Date: 02/18/2022
Certification Date: 02/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6515 INDIAN ACRES TRL
TUCKER GA
30084-1617
US

IV. Provider business mailing address

6515 INDIAN ACRES TRL
TUCKER GA
30084-1617
US

V. Phone/Fax

Practice location:
  • Phone: 770-235-6160
  • Fax:
Mailing address:
  • Phone: 770-235-6160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MARYUM MEHDEWI MOHEBI
Title or Position: ADMINISTRATOR
Credential:
Phone: 770-235-6160