Provider Demographics
NPI:1073851333
Name:S & S PRIVATE HOME CARE, LLC
Entity type:Organization
Organization Name:S & S PRIVATE HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHAKITA
Authorized Official - Middle Name:
Authorized Official - Last Name:RANDLE-LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-573-7477
Mailing Address - Street 1:1208 WHISPERING PINES RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-3552
Mailing Address - Country:US
Mailing Address - Phone:229-573-7477
Mailing Address - Fax:229-329-4474
Practice Address - Street 1:1208 WHISPERING PINES RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-3552
Practice Address - Country:US
Practice Address - Phone:229-573-7477
Practice Address - Fax:229-329-4474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-22
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAB13-000011251E00000X
GAAB15-000411251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health