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General NPI Number Information
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NPI Number | 1750039798
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Entity Type | Organization
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Legal Business Name | DASOM HOMECARE AGENCY LLC
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Dates
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Enumeration Date | 03/17/2022
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Last Update Date | 09/26/2023
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Provider Practice Location Address
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Address Line | 1238 FORT MARCY PARK
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City | LAWRENCEVILLE
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State | GA
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Zip | 30044-3489
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Country | US
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Telephone | 678-925-7370
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Fax | 888-342-1617
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Provider Business Mailing Address
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Address Line | 3230 STEVE REYNOLDS BOULEVARD STE 214
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City | DULUTH
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State | GA
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Zip | 30096-8833
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Country | US
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Telephone | 470-282-1966
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Fax | 888-342-1617
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. MICHELLE BOGO KIM
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Credential |
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Telephone | 770-572-8707
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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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