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Organization
MYSTIQUE HOMECARE AGENCY
Active
Organization
MYSTIQUE HOMECARE AGENCY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BUKOLA SHOLANKE (ADMINISTRATOR)
(470) 509-5533
Entity
Organization
Contact information
Practice address
3675 CRESTWOOD PKWY NW STE 400, DULUTH, GA 30096-5054
(470) 509-5533
(470) 625-3368
Mailing address
3675 CRESTWOOD PKWY NW STE 400, DULUTH, GA 30096-5054
(470) 509-5533
(470) 625-3368
Taxonomy
Speciality
Code
Description
License number
State
251G00000X
Community Based Hospice Care Agency
—
NULL
253Z00000X
In Home Supportive Care Agency
Primary
—
NULL
Other
Enumeration date
07/01/2020
Last updated
10/10/2020
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