Provider Demographics
NPI:1316781933
Name:SECURED HOME CARE LLC
Entity type:Organization
Organization Name:SECURED HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:IBISO
Authorized Official - Last Name:OBENOFUNDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-667-0255
Mailing Address - Street 1:33 PARKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30157-4616
Mailing Address - Country:US
Mailing Address - Phone:404-667-0255
Mailing Address - Fax:
Practice Address - Street 1:33 PARKSIDE DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30157-4616
Practice Address - Country:US
Practice Address - Phone:404-667-0255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-19
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty
No251E00000XAgenciesHome Health
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty