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General NPI Number Information
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NPI Number | 1740778463
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Entity Type | Organization
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Legal Business Name | IMMACULATE HEALTHCARE SOLUTIONS, LLC
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Dates
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Enumeration Date | 04/27/2018
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Last Update Date | 10/23/2019
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Provider Practice Location Address
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Address Line | 970 PEACHTREE INDUSTRIAL BLVD STE 8
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City | SUWANEE
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State | GA
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Zip | 30024
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Country | US
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Telephone | 404-944-9516
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Fax |
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Provider Business Mailing Address
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Address Line | 970 PEACHTREE INDUSTRIAL BLVD STE 8
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City | SUWANEE
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State | GA
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Zip | 30024-6988
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Country | US
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Telephone | 678-707-2369
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TIMOTHY IJEH
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Credential |
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Telephone | 404-944-9516
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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