Organization
BIG MOMMAS' HOUSE PCH INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HANIYYAH INTARSAR ABDUL-AZIZ (CEO)
(678) 418-3007
Entity
Organization
Contact information
Practice address
4791 GOLOD WAY, LITHONIA, GA 30038-6297
(678) 418-3007
(678) 418-9958
Mailing address
4791 GOLOD WAY, LITHONIA, GA 30038-6297
(678) 418-3007
(678) 418-9958
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
654081001A
—
GA
Enumeration date
12/17/2009
Last updated
12/17/2009
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