Provider Demographics
NPI:1699943936
Name:FIRST OPPORTUNITY HOME HEALTHCARE,LLC.
Entity type:Organization
Organization Name:FIRST OPPORTUNITY HOME HEALTHCARE,LLC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:KENDRA
Authorized Official - Middle Name:BARDARA
Authorized Official - Last Name:OUTRAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-422-4940
Mailing Address - Street 1:3113 CALIENTE LN
Mailing Address - Street 2:
Mailing Address - City:REX
Mailing Address - State:GA
Mailing Address - Zip Code:30273-1002
Mailing Address - Country:US
Mailing Address - Phone:678-422-4940
Mailing Address - Fax:678-422-4940
Practice Address - Street 1:3113 CALIENTE LN
Practice Address - Street 2:
Practice Address - City:REX
Practice Address - State:GA
Practice Address - Zip Code:30273-1002
Practice Address - Country:US
Practice Address - Phone:678-422-4940
Practice Address - Fax:678-422-4940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2872851Medicaid