Provider Demographics
NPI:1083009054
Name:CERTIFIED HOME CARE OF GEORGIA LLC
Entity type:Organization
Organization Name:CERTIFIED HOME CARE OF GEORGIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUDINE
Authorized Official - Middle Name:
Authorized Official - Last Name:LYNCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-635-8042
Mailing Address - Street 1:2559 PHARR AVE
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-4707
Mailing Address - Country:US
Mailing Address - Phone:770-635-8042
Mailing Address - Fax:888-599-5057
Practice Address - Street 1:382 HARBINS RD
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-2300
Practice Address - Country:US
Practice Address - Phone:770-635-8042
Practice Address - Fax:877-366-0737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-06
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care