Provider Demographics
NPI:1962156935
Name:HIGH LEVEL HOME CARE LLC
Entity type:Organization
Organization Name:HIGH LEVEL HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-415-6370
Mailing Address - Street 1:4686 LAKE VISTA CIR
Mailing Address - Street 2:
Mailing Address - City:ELLENWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30294-1698
Mailing Address - Country:US
Mailing Address - Phone:770-568-7812
Mailing Address - Fax:
Practice Address - Street 1:4686 LAKE VISTA CIR
Practice Address - Street 2:
Practice Address - City:ELLENWOOD
Practice Address - State:GA
Practice Address - Zip Code:30294-1698
Practice Address - Country:US
Practice Address - Phone:770-568-7812
Practice Address - Fax:770-234-6075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GANONEOtherNONE