MYSTIQUE HOMECARE AGENCY (NPI# 1750908018) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1750908018 |
| Entity Type | Organization |
| Organization Name | MYSTIQUE HOMECARE AGENCY |
| Practice Address |
3675 Crestwood Pkwy Nw Ste 400 Duluth GA 30096-5054 |
| Practice Telephone | 4705095533 |
| Practice Fax Number | 4706253368 |
| Mailing Telephone | 4705095533 |
| Mailing Fax Number | 4706253368 |
| Enumeration Date | 2020-07-01 |
| Last Update Date | 2020-10-10 |
| Authorized Official Name | BUKOLA SHOLANKE (ADMINISTRATOR) |
| Authorized Official Telephone | 4705095533 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 251G00000X | Hospice Care, Community Based | Agencies | ||
| Y | 253Z00000X | In Home Supportive Care | Agencies |
| Street Address |
3675 CRESTWOOD PKWY NW STE 400 |
| City | DULUTH |
| State | GA |
| Zip Code | 30096-5054 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942604814 | Vanessa George-king | Counselor | 3675 Crestwood Pkwy Nw Ste 400, Duluth, GA 30096-5054 | 2014-10-21 |
| 1679101612 | Ashley Murphy | Counselor | 3675 Crestwood Pkwy Nw Ste 400, Duluth, GA 30096-5054 | 2020-03-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922615897 | Georgia Eye Optical, LLC | Ophthalmology | 3800 Pleasant Hill Rd Ste 3, Duluth, GA 30096 | 2020-09-25 |
| 1568090868 | Positive Behavior Services, Inc | Behavior Technician | 3765 Crestwood Pkwy Nw, Duluth, GA 30096 | 2020-03-31 |
| 1861031940 | Elizabeth Ashley Edouard | Counselor | 3464 Duluth Hwy 120, Duluth, GA 30096 | 2020-01-06 |
| 1245701044 | Kathryn Irene Vaughn | Social Worker | 3968 Mainsail Court, Duluth, GA 30096 | 2018-12-06 |
| 1083184626 | Aica Orthopedics, P.C. | Orthopaedic Surgery | 3775 Venture Drive Bldg F, Duluth, GA 30096 | 2018-11-27 |
| 1245709799 | Positive Impact Health Centers, Inc. | Pharmacy | 3350 Breckinridge Blvd, Suite 200a, Duluth, GA 30096 | 2018-11-14 |
| 1235611724 | Katherine Winstead Knott | Counselor | 3460 Summit Ridge Parkway, Suite 503, Duluth, GA 30096 | 2018-08-31 |
| 1710467857 | Envision Optics LLC | Optometrist | 1943 Pleasant Hill Rd, Duluth, GA 30096 | 2018-08-17 |
| 1104314202 | Erin Mckernan Scupham | Chiropractor | 3820 Pleasant Hill Rd. Ne, Suite 4, Duluth, GA 30096 | 2018-04-25 |
| 1053839456 | Rogers Bridge Pediatric Therapy, LLC | Clinic/Center | 2845 Summercrest Ln, Duluth, GA 30096 | 2017-09-06 |
| Find all providers in zip 30096 | ||||
| Taxonomy Code | 253Z00000X |
| Grouping | Agencies |
| Classification | In Home Supportive Care |
| An In Home Supportive Care Agency provides services in the patient’s home with the goal of enabling the patient to remain at home. The services provided may include personal care services such as hands-on assistance with activities of daily living (ADLs), e.g., eating, bathing, dressing, and bladder and bowel requirements; homemaker services and instrumental activities of daily living (IADLs), e.g., taking medications, shopping for groceries, laundry, housekeeping, and companionship; and/or supervision or cuing so that a person can perform tasks themselves. |
| Notes: Source: National Uniform Claim Committee, 2008 [7/1/2008: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053921528 | Patricia Julien | In Home Supportive Care | 3392 Briaroak Dr, Duluth, GA 30096-8949 | 2020-08-08 |
| 1417514852 | Us Healthcare LLC | In Home Supportive Care | 3741 Venture Dr Ste 310, Duluth, GA 30096-8266 | 2019-05-21 |
| 1184119059 | Angel Home, Inc. | In Home Supportive Care | 2607 Rhonda Ct, Duluth, GA 30096-4128 | 2018-06-24 |
| 1245503499 | Homehelpers | In Home Supportive Care | 3159 Dover Dr, Duluth, GA 30096-3524 | 2012-02-20 |
| 1215543897 | Allegiant In Home Care LLC | In Home Supportive Care | 2180 Satellite Blvd Ste 400, Duluth, GA 30097-4927 | 2020-09-19 |
| 1407465099 | Silver Linings Home Care LLC | In Home Supportive Care | 3186 Creston Park Ct, Duluth, GA 30096-8959 | 2020-07-29 |
| 1700263373 | Far From Par, LLC | In Home Supportive Care | 1827 E Superior St, Duluth, MN 55812-2044 | 2015-05-02 |
| 1497181721 | Access North Center for Independent Living | In Home Supportive Care | 118 E Superior St, Duluth, MN 55802-2155 | 2013-09-18 |
| 1265767099 | Sascha Mansson Dba Touching Hearts At Home | In Home Supportive Care | 314 W Superior St, Suite 310, Duluth, MN 55802-1805 | 2009-10-13 |
| 1013155159 | Seniors First Choice Inc | In Home Supportive Care | 9810a Medlock Bridge Rd, Suite 102, Duluth, GA 30097-2016 | 2009-01-28 |
| Find all providers in DULUTH | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.