Provider Demographics
NPI:1588263917
Name:963 HZ LLC
Entity type:Organization
Organization Name:963 HZ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JOURNEE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:770-298-8555
Mailing Address - Street 1:621 ARBOR CIR
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-3061
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:621 ARBOR CIR
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-3061
Practice Address - Country:US
Practice Address - Phone:770-298-5555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:963 HZ LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-10-17
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health