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General NPI Number Information
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NPI Number | 1306506118
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Entity Type | Organization
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Legal Business Name | MAURINA PRIVATE HOMECARE LLC
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Dates
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Enumeration Date | 12/20/2021
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Last Update Date | 09/20/2023
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Provider Practice Location Address
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Address Line | 220 BETHEL DR
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City | DALLAS
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State | GA
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Zip | 30157-6814
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Country | US
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Telephone | 404-973-0500
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Fax |
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Provider Business Mailing Address
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Address Line | 251 WHITE PINES DR
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City | DALLAS
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State | GA
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Zip | 30157-8512
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MAUREEN GICHARU
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Credential |
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Telephone | 404-973-0500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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