Organization
AGELESS PRIVATE HOME HEALTHCARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACQUELINE PEAN REGISTERED NURSE (OWNER)
(404) 553-6671
Entity
Organization
Contact information
Practice address
3188 KRISAM CREEK DR, LOGANVILLE, GA 30052-7907
(404) 553-6671
Mailing address
3188 KRISAM CREEK DR, LOGANVILLE, GA 30052-7907
(404) 553-6671
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
067-R-0498
GA
Other
Enumeration date
05/30/2010
Last updated
05/30/2010
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