Organization
ST ALIZABETH PRIMARY HOMECARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM OGLESBY JR. CEO (ADMINISTRATOR/OWNER)
(478) 420-2307
Entity
Organization
Contact information
Practice address
1707 ZACHARYS WAY, MCDONOUGH, GA 30253-9026
(478) 420-2307
Mailing address
1707 ZACHARYS WAY, MCDONOUGH, GA 30253-9026
(478) 420-2307
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
3747P1801X
Personal Care Attendant
Primary
—
—
Other
Enumeration date
02/28/2023
Last updated
03/02/2023
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