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General NPI Number Information
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NPI Number | 1598214181
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Entity Type | Organization
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Legal Business Name | A&C PRIVATE HOME CARE, LLC
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Dates
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Enumeration Date | 09/24/2016
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Last Update Date | 09/24/2016
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Provider Practice Location Address
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Address Line | 4855 IVY RIDGE DR SE UNIT 405
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City | ATLANTA
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State | GA
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Zip | 30339-1367
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Country | US
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Telephone | 770-776-6637
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Fax |
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Provider Business Mailing Address
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Address Line | 4855 IVY RIDGE DR SE UNIT 405
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City | ATLANTA
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State | GA
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Zip | 30339-1367
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Country | US
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Telephone | 770-776-6637
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | ANGELA C AGWUNOB
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Credential |
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Telephone | 770-776-6637
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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 | 033-R-1499
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License Number State | GA
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