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General NPI Number Information
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NPI Number | 1720660616
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Entity Type | Organization
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Legal Business Name | EPSILON HOME BASED QUALITY CARE, LLC
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Dates
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Enumeration Date | 04/21/2021
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Last Update Date | 04/21/2021
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Provider Practice Location Address
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Address Line | 1350 SCENIC HWY N STE 266
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City | SNELLVILLE
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State | GA
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Zip | 30078-7924
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Country | US
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Telephone | 770-824-3940
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Fax | 770-415-3008
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Provider Business Mailing Address
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Address Line | 1334 GULFPORT RUN
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City | GRAYSON
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State | GA
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Zip | 30017-2949
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Country | US
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Telephone | 770-824-3940
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Fax | 770-415-3008
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Authorized Official
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Title or Position | CEO, MANAGER
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Name | GLAVDIA G DELVA
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Credential | MD, MPH
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Telephone | 516-309-3510
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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 |
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License Number State |
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