Organization
GEORGIA IN HOME SUPPORT SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SHANTEL MARIE FORSTALL MSW (ADMINISTRATOR)
(678) 817-7338
Entity
Organization
Contact information
Practice address
155 ZELKOVA DR, FAYETTEVILLE, GA 30215-2528
(678) 817-7338
Mailing address
155 ZELKOVA DR, FAYETTEVILLE, GA 30215-2528
(678) 817-7338
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
056-R-0260
GA
251J00000X
Nursing Care Agency
056-R-0260
GA
Other
Enumeration date
08/12/2006
Last updated
09/11/2025
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