# SHANNON PRIVATE HOME CARE, INC.

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

## Provider details

- **NPI number:** 1376643692
- **Authorized official:** DARRIUS E, SHANNON (ADMINISTRATOR)
- **Authorized official phone:** (678) 479-2027

## Contact information

- **Practice address:** 7080 GREEN VALLEY LN, RIVERDALE, GA 30274-3206
- **Practice address phone:** (678) 479-2027
- **Mailing address:** PO BOX 961346, RIVERDALE, GA 30296-6904
- **Mailing address phone:** (678) 479-2027

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 09/25/2006
- **Last updated:** 08/22/2020