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General NPI Number Information
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NPI Number | 1376084954
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Entity Type | Organization
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Legal Business Name | QUEENAIR TLC HOME SERVICES
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Dates
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Enumeration Date | 03/15/2017
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Last Update Date | 03/15/2017
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Provider Practice Location Address
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Address Line | 2072 BEN HILL RD
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City | EAST POINT
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State | GA
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Zip | 30344-4124
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Country | US
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Telephone | 470-302-3983
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Fax |
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Provider Business Mailing Address
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Address Line | 2072 BEN HILL RD
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City | EAST POINT
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State | GA
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Zip | 30344-4124
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Country | US
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Telephone | 470-302-3983
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AIRQUETTA SHUVONNE HOLDEN
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Credential |
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Telephone | 678-789-1116
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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 | 253Z00000X
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License Number State |
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