Provider Demographics
NPI:1336986348
Name:AWESOME PERSONAL HOME CARE LLC
Entity type:Organization
Organization Name:AWESOME PERSONAL HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:OBI
Authorized Official - Last Name:NWOLISA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-484-0845
Mailing Address - Street 1:7190 WALTON RESERVE LN
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30168-2550
Mailing Address - Country:US
Mailing Address - Phone:404-484-0845
Mailing Address - Fax:
Practice Address - Street 1:7190 WALTON RESERVE LN
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30168-2550
Practice Address - Country:US
Practice Address - Phone:404-484-0845
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-09
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care