Provider Demographics
NPI:1528733235
Name:PIEDMONT HOMECARE SERVICES LLC
Entity type:Organization
Organization Name:PIEDMONT HOMECARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:COLLINS
Authorized Official - Middle Name:OBINNA
Authorized Official - Last Name:LIVINUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-246-2166
Mailing Address - Street 1:773 HIGHWAY 138 SW STE 13
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30296-1599
Mailing Address - Country:US
Mailing Address - Phone:404-937-9943
Mailing Address - Fax:770-731-2641
Practice Address - Street 1:773 HIGHWAY 138 SW STE 13
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30296-1599
Practice Address - Country:US
Practice Address - Phone:404-937-9943
Practice Address - Fax:770-731-2641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-13
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health