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General NPI Number Information
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NPI Number | 1841739984
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Entity Type | Organization
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Legal Business Name | UNDER THE SHADOWS PRIVATE HOME CARE
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Dates
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Enumeration Date | 02/22/2017
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Last Update Date | 02/22/2017
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Provider Practice Location Address
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Address Line | 208 CURTIS STREET
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City | SYLVANIA
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State | GA
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Zip | 30467
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Country | US
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Telephone | 912-978-8282
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Fax |
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Provider Business Mailing Address
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Address Line | 208 CURTIS ST
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City | SYLVANIA
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State | GA
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Zip | 30467-2432
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Country | US
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Telephone | 912-564-5865
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. LATRELL JENKINS
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Credential |
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Telephone | 912-978-8282
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 047470140
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License Number State | GA
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