# MOFAZZAL SURAIYA LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** m and s homecare services
- **Organization subpart:** No

## Provider details

- **NPI number:** 1962703082
- **Authorized official:** MR. JAMIL IMRAN (PRESIDENT)
- **Authorized official phone:** (404) 587-8500

## Contact information

- **Practice address:** 2775 CRUSE RD STE 101, LAWRENCEVILLE, GA 30044-7141
- **Practice address phone:** (404) 587-8500
- **Practice address fax:** (770) 939-5682
- **Mailing address:** 1015 OMAHA DR, NORCROSS, GA 30093-4967
- **Mailing address phone:** (404) 587-8500
- **Mailing address fax:** (770) 939-5682

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 253Z00000X | In Home Supportive Care Agency | 067-R-0459 | GA | Yes |

## Other

- **Enumeration date:** 11/05/2010
- **Last updated:** 11/05/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 221998235A | — | GA |