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General NPI Number Information
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NPI Number | 1124487376
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Entity Type | Organization
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Legal Business Name | COMPLETE CARE AT HOME, LLC
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Dates
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Enumeration Date | 02/16/2016
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Last Update Date | 05/05/2017
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Provider Practice Location Address
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Address Line | 11 DUNWOODY PARK SUITE 140
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City | DUNWOODY
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State | GA
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Zip | 30338-7408
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Country | US
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Telephone | 770-551-9533
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Fax |
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Provider Business Mailing Address
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Address Line | 11 DUNWOODY PARK SUITE 140
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City | DUNWOODY
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State | GA
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Zip | 30338-7408
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Country | US
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Telephone | 770-551-9533
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. LISA MARLEEN REISMAN
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Credential | MSN, CNP
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Telephone | 770-551-9533
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | 060-R-0250
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 060-R-0250
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License Number State | GA
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