Provider Demographics
NPI:1215614482
Name:1ST GWINNETT HOME CARE LLC
Entity type:Organization
Organization Name:1ST GWINNETT HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:NDINGWAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-396-4827
Mailing Address - Street 1:35 FIRST ST STE 2
Mailing Address - Street 2:
Mailing Address - City:HOSCHTON
Mailing Address - State:GA
Mailing Address - Zip Code:30548-2234
Mailing Address - Country:US
Mailing Address - Phone:770-318-7530
Mailing Address - Fax:
Practice Address - Street 1:1743 CROSSWATERS CT
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-1729
Practice Address - Country:US
Practice Address - Phone:612-396-4827
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-29
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care