=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316781933
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SECURED HOME CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/19/2024
-----------------------------------------------------
Last Update Date | 10/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1667 CANTON RD STE B
-----------------------------------------------------
City | MARIETTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30066-6491
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-667-0255
-----------------------------------------------------
Fax | 877-570-2351
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1667 CANTON RD STE B
-----------------------------------------------------
City | MARIETTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30066-6491
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-667-0255
-----------------------------------------------------
Fax | 877-570-2351
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | PAMELA IBISO OBENOFUNDE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 404-667-0255
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 374U00000X
-----------------------------------------------------
Taxonomy Name | Home Health Aide
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------