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General NPI Number Information
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NPI Number | 1760924278
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Entity Type | Organization
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Legal Business Name | DIVERSIFIED PERSONAL HOME CARE
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Dates
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Enumeration Date | 11/15/2016
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Last Update Date | 03/28/2017
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Provider Practice Location Address
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Address Line | 145 MCINTOSH PLACE DR
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-7318
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Country | US
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Telephone | 404-993-1270
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Fax |
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Provider Business Mailing Address
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Address Line | 145 MCINTOSH PLACE DR
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-7318
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | ADESOLA OSILAJA
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Credential |
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Telephone | 404-993-1270
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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License Number | 056-R-1338
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 311500000X
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Taxonomy Name | Alzheimer Center (Dementia Center)
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License Number | 056-R-1338
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License Number State | GA
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Taxonomy #3
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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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