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Organization
DIVERSIFIED PERSONAL HOME CARE
Active
Organization
DIVERSIFIED PERSONAL HOME CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ADESOLA OSILAJA (OWNER/CEO)
(404) 993-1270
Entity
Organization
Contact information
Practice address
145 MCINTOSH PLACE DR, FAYETTEVILLE, GA 30214-7318
(404) 993-1270
Mailing address
145 MCINTOSH PLACE DR, FAYETTEVILLE, GA 30214-7318
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
NULL
311500000X
Alzheimer Center (Dementia Center)
056-R-1338
GA
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
056-R-1338
GA
Other
Enumeration date
11/15/2016
Last updated
03/28/2017
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