# SOUTHERN CRESCENT HOME CARE

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

## Provider details

- **NPI number:** 1295065175
- **Authorized official:** MR. JONATHAN ONYIBO MOH (ADMINISTRATOR)
- **Authorized official phone:** (678) 360-6003

## Contact information

- **Practice address:** 1351 GRINDENWALD DR, JONESBORO, GA 30238-8001
- **Practice address phone:** (678) 360-6003
- **Practice address fax:** (770) 472-0107
- **Mailing address:** 1351 GRINDENWALD DR, JONESBORO, GA 30238-8001
- **Mailing address phone:** (678) 360-6003
- **Mailing address fax:** (770) 472-0107

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 253Z00000X | In Home Supportive Care Agency | 031-R-0360 | GA | Yes |

## Other

- **Enumeration date:** 12/28/2009
- **Last updated:** 12/28/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 164763686A | — | GA |