Provider Demographics
NPI:1538791413
Name:LEAGUE OF PRIVATE HOMECARE
Entity type:Organization
Organization Name:LEAGUE OF PRIVATE HOMECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:WALTER
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:470-377-1829
Mailing Address - Street 1:5310 ARBOR GATES DR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-5619
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5310 ARBOR GATES DR NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-5619
Practice Address - Country:US
Practice Address - Phone:470-377-1829
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-07
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care