Provider Demographics
NPI:1679155824
Name:COMPANION CARE OF GEORGIA, LLC
Entity type:Organization
Organization Name:COMPANION CARE OF GEORGIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:912-685-4540
Mailing Address - Street 1:46875 GA HIGHWAY 46 E
Mailing Address - Street 2:
Mailing Address - City:METTER
Mailing Address - State:GA
Mailing Address - Zip Code:30439-4936
Mailing Address - Country:US
Mailing Address - Phone:912-685-4540
Mailing Address - Fax:912-685-4540
Practice Address - Street 1:46875 GA HIGHWAY 46 E
Practice Address - Street 2:
Practice Address - City:METTER
Practice Address - State:GA
Practice Address - Zip Code:30439-4936
Practice Address - Country:US
Practice Address - Phone:912-685-4540
Practice Address - Fax:912-685-4540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty