# SANGUINE REVERE LLC

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

## Provider details

- **NPI number:** 1295568178
- **Authorized official:** KHALLIS JOYNER (OWNER)
- **Authorized official phone:** (404) 610-7689

## Contact information

- **Practice address:** 7460 AMBASSADOR DR, RIVERDALE, GA 30296-1928
- **Practice address phone:** (404) 610-7689
- **Mailing address:** 7460 AMBASSADOR DR, RIVERDALE, GA 30296-1928
- **Mailing address phone:** (404) 610-7689

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | — | NULL | Yes |
| 253Z00000X | In Home Supportive Care Agency | — | NULL | — |
| 310400000X | Assisted Living Facility | — | NULL | — |
| 311ZA0620X | Adult Care Home Facility | — | NULL | — |
| 343900000X | Non-emergency Medical Transport (VAN) | — | NULL | — |

## Other

- **Enumeration date:** 08/26/2024
- **Last updated:** 08/26/2024