Provider Demographics
NPI:1316831472
Name:WALLYMANG HOMECARE AND STAFFING AGENCY LLC
Entity type:Organization
Organization Name:WALLYMANG HOMECARE AND STAFFING AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FATOUMATTA
Authorized Official - Middle Name:
Authorized Official - Last Name:MINTEH
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:678-758-0116
Mailing Address - Street 1:3070 CAMELLIA TRL
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-2678
Mailing Address - Country:US
Mailing Address - Phone:678-758-0116
Mailing Address - Fax:
Practice Address - Street 1:3070 CAMELLIA TRL
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-2678
Practice Address - Country:US
Practice Address - Phone:678-758-0116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-04
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251J00000XAgenciesNursing Care
No174200000XOther Service ProvidersMeals
No251G00000XAgenciesHospice Care, Community Based
No385H00000XRespite Care FacilityRespite Care
No385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child