Provider Demographics
NPI:1063794154
Name:BISOL HOME CARE SERVICES, INC
Entity type:Organization
Organization Name:BISOL HOME CARE SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ADEBISI
Authorized Official - Middle Name:O
Authorized Official - Last Name:ADEWAKUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-285-7276
Mailing Address - Street 1:1234 JULIE CT
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30296-2254
Mailing Address - Country:US
Mailing Address - Phone:404-285-7276
Mailing Address - Fax:
Practice Address - Street 1:2759 MOUNT ZION PKWY
Practice Address - Street 2:SUITE D
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-2568
Practice Address - Country:US
Practice Address - Phone:404-285-7276
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-14
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA031-R-0745253Z00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care