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General NPI Number Information
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NPI Number | 1730313222
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Entity Type | Organization
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Legal Business Name | SAFEWAY HEALTHCARE, INC.
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Dates
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Enumeration Date | 05/12/2009
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Last Update Date | 06/09/2015
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Provider Practice Location Address
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Address Line | 3846 WOOD HOLLOW WAY
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City | SNELLVILLE
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State | GA
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Zip | 30039-6080
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Country | US
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Telephone | 770-255-9500
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Fax | 770-733-1329
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Provider Business Mailing Address
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Address Line | 2386 CLOWER STREET, BUILDING C, SUITE 209
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City | SNELLVILLE
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State | GA
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Zip | 30078-6108
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Country | US
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Telephone | 770-255-9500
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Fax | 770-733-1329
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. BENSON NOSA AGBONAVBARE
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Credential |
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Telephone | 770-255-9500
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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 | 44-R-0203
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License Number State | GA
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