Provider Demographics
NPI:1316900285
Name:LONE SHEPHERD HOMECARE SERVICES
Entity type:Organization
Organization Name:LONE SHEPHERD HOMECARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHACHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-246-4935
Mailing Address - Street 1:4007 SNOWSHOE CT NW
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-7371
Mailing Address - Country:US
Mailing Address - Phone:404-246-4935
Mailing Address - Fax:770-974-1020
Practice Address - Street 1:4007 SNOWSHOE CT NW
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-7371
Practice Address - Country:US
Practice Address - Phone:404-246-4935
Practice Address - Fax:770-974-1020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033R0109251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health