Organization
TRYST PRIVATE HOMECARE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MODUPE OLUYEMISI SALAMI FNP (CEO)
(770) 598-7558
Entity
Organization
Contact information
Practice address
331 BLACK WILLOW CT, LOCUST GROVE, GA 30248-6606
(770) 598-7558
(678) 432-5075
Mailing address
331 BLACK WILLOW CT, LOCUST GROVE, GA 30248-6606
(770) 598-7558
(678) 432-5075
Taxonomy
Speciality
Code
Description
License number
State
251J00000X
Nursing Care Agency
Primary
075-R-0884
GA
Other
Enumeration date
07/08/2013
Last updated
07/08/2013
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