# BLACKLAND HOME CARE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1215239710
- **Authorized official:** MR. KEVIN P HANNAN (DIRECTOR)
- **Authorized official phone:** (404) 518-9522

## Contact information

- **Practice address:** 177 ENNISBROOK DR SE, SMYRNA, GA 30082-2451
- **Practice address phone:** (678) 823-8155
- **Practice address fax:** (678) 823-8156
- **Mailing address:** 177 ENNISBROOK DR SE, SMYRNA, GA 30082-2451
- **Mailing address phone:** (678) 823-8155
- **Mailing address fax:** (678) 823-8156

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | RN 188675 | GA | Yes |

## Other

- **Enumeration date:** 12/03/2010
- **Last updated:** 12/03/2010