Provider Demographics
NPI:1306450796
Name:THE HARMONY HOME OF KITCHENS ROAD, LLC
Entity type:Organization
Organization Name:THE HARMONY HOME OF KITCHENS ROAD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LASE
Authorized Official - Middle Name:VERA ANN
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-696-2028
Mailing Address - Street 1:255 RACETRACK RD STE 25
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30252-6834
Mailing Address - Country:US
Mailing Address - Phone:478-696-2028
Mailing Address - Fax:
Practice Address - Street 1:255 RACETRACK RD STE 25
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30252-6834
Practice Address - Country:US
Practice Address - Phone:478-696-2028
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-02
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1689230898Medicaid