Organization
SHANNON PRIVATE HOME CARE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DARRIUS E, SHANNON (ADMINISTRATOR)
(678) 479-2027
Entity
Organization
Contact information
Practice address
7080 GREEN VALLEY LN, RIVERDALE, GA 30274-3206
(678) 479-2027
Mailing address
PO BOX 961346, RIVERDALE, GA 30296-6904
(678) 479-2027
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Enumeration date
09/25/2006
Last updated
08/22/2020
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