=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609734383
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHAJEH HOME CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/12/2026
-----------------------------------------------------
Last Update Date | 01/12/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 925 MAIN ST STE 30021
-----------------------------------------------------
City | STONE MOUNTAIN
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30083-3098
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 470-469-2850
-----------------------------------------------------
Fax | 470-469-2850
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 925 MAIN ST STE 30021
-----------------------------------------------------
City | STONE MOUNTAIN
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30083-3098
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 470-469-2850
-----------------------------------------------------
Fax | 470-469-2850
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AUTHORIZED OFFICIAL
-----------------------------------------------------
Name | MR. OLUSHOLA OKIEI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 470-469-2850
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------