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General NPI Number Information
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NPI Number | 1346612512
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Entity Type | Organization
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Legal Business Name | ASSISTCARE, INC.
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Dates
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Enumeration Date | 10/27/2015
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Last Update Date | 10/27/2015
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Provider Practice Location Address
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Address Line | 3576 CHAMBLEE TUCKER RD
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City | ATLANTA
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State | GA
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Zip | 30341-4424
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Country | US
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Telephone | 404-836-1989
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Fax |
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Provider Business Mailing Address
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Address Line | 3576 CHAMBLEE TUCKER RD
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City | ATLANTA
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State | GA
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Zip | 30341-4424
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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 | CFO/OWNER
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Name | PANOME THEPMANIVONG
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Credential |
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Telephone | 678-557-2229
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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