MEDICARE: SHAJEH HOME CARE 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1609734383
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHAJEH HOME CARE LLC

Provider Business Mailing Address
First Line	:	925 MAIN ST STE 30021
Second Line	:
City	:	STONE MOUNTAIN
State	:	GA
Zip	:	30083-3098
Country	:	US
Telephone Number	:	470-469-2850
Fax Number	:	470-469-2850

Provider Business Practice Location Address
First Line	:	925 MAIN ST STE 30021
Second Line	:
City	:	STONE MOUNTAIN
State	:	GA
Zip	:	30083-3098
Country	:	US
Telephone Number	:	470-469-2850
Fax Number	:	470-469-2850

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	MR. OLUSHOLA OKIEI
Credential	:
Telephone Number	:	470-469-2850

Provider Enumeration Date	:	01/12/2026
Last Update Date	:	01/12/2026

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