Healthcare Provider Details

I. General information

NPI: 1376329425
Provider Name (Legal Business Name): ATHENS HOME CARE SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2023
Last Update Date: 09/05/2023
Certification Date: 11/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E MILL
ATHENS MI
49011-5110
US

IV. Provider business mailing address

PO BOX 262
ATHENS MI
49011-0262
US

V. Phone/Fax

Practice location:
  • Phone: 269-275-3559
  • Fax:
Mailing address:
  • Phone: 269-275-3559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name: PENNIE JEWELL
Title or Position: CEO
Credential:
Phone: 269-275-3559