MEDICARE: MOMMYS DAY OFF, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1427717750
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOMMYS DAY OFF, LLC

Provider Business Mailing Address
First Line	:	8491 HOSPITAL DR # 444
Second Line	:
City	:	DOUGLASVILLE
State	:	GA
Zip	:	30134-2412
Country	:	US
Telephone Number	:	706-804-2468
Fax Number	:

Provider Business Practice Location Address
First Line	:	2806 LANDRUM DR SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30311-4302
Country	:	US
Telephone Number	:	240-413-3103
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TREJONDA MOMENT
Credential	:
Telephone Number	:	706-804-2468

Provider Enumeration Date	:	12/14/2021
Last Update Date	:	12/14/2021

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