1SOURCE FITNESS & SPORTS NEURO REHAB (NPI# 1184174161) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1184174161 |
| Entity Type | Organization |
| Organization Name | 1SOURCE FITNESS & SPORTS NEURO REHAB |
| Other Organization Name | 1SOURCE HEALTH SERVICES |
| Practice Address |
4728 Joseph Eli Dr Snellville GA 30039-7138 |
| Practice Telephone | 6782574037 |
| Practice Fax Number | 6782574037 |
| Mailing Telephone | 6782574037 |
| Mailing Fax Number | 6782574037 |
| Enumeration Date | 2016-10-13 |
| Last Update Date | 2016-10-13 |
| Authorized Official Name | COLLIN ADU (CLINICAL DIRECTOR) |
| Authorized Official Telephone | 6782504035 |
| Authorized Official Credential | DPT.GCS. MBA |
| Is Organization Subpart | Y |
| Parent Organization Name | 1SOURCE FITNESS & SPORTS NEURO REHAB |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 251E00000X | Home Health | 12002969 | GA | Agencies |
| Other Name | Type Code |
|---|---|
| 1Source Health Services | Other Name - Individual/Organization |
| Street Address |
4728 JOSEPH ELI DR |
| City | SNELLVILLE |
| State | GA |
| Zip Code | 30039-7138 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710593819 | David Spellings | Physical Therapist | 3991 Us-78, Suite 200, Snellville, GA 30039 | 2020-09-23 |
| 1245849785 | Tanner Brown | Physical Therapist | 3991 Us-78 Suite 200, Snellville, GA 30039 | 2020-07-30 |
| 1215571294 | Ora Gylbryne Brown | Behavioral Analyst | 4189 White Road, Snellville, GA 30039 | 2019-11-01 |
| 1780174953 | Kolawole J Adeyeye | Nursing Care | 4729 Polly Pl, Snellville, GA 30039 | 2018-05-14 |
| 1255820007 | Bacchus Private Home Care LLC | Home Health | 4925 Bridle Point Parkway, Snellville, GA 30039 | 2018-05-08 |
| 1508368051 | Sovereign Medical Services, Inc | Community/Behavioral Health | 3806 Wood Hollow Way, Snellville, GA 30039 | 2018-03-01 |
| 1356865265 | Shanique Griffiths | Counselor | 2580 Broadmoor Ct, Snellville, GA 30039 | 2017-08-01 |
| 1265952584 | Miracles In Motion Foundation | Case Management | 4276 Burgomeister Place, Snellville, GA 30039 | 2017-06-27 |
| 1194245704 | Loliya Joy Stewart | Dentist | 3966 Annistown Rd, Snellville, GA 30039 | 2017-06-24 |
| 1023543014 | Natasha Marie Smith | Nurse's Aide | 2423 Northbrook Rd, Snellville, GA 30039 | 2017-04-27 |
| Find all providers in zip 30039 | ||||
| Taxonomy Code | 251E00000X |
| Grouping | Agencies |
| Classification | Home Health |
| A public agency or private organization, or a subdivision of such an agency or organization, that is primarily engaged in providing skilled nursing services and other therapeutic services, such as physical therapy, speech-language pathology services, or occupational therapy, medical social services, and home health aide services. It has policies established by a professional group associated with the agency or organization (including at least one physician and one registered nurse) to govern the services and provides for supervision of such services by a physician or a registered nurse; maintains clinical records on all patients; is licensed in accordance with State or local law or is approved by the State or local licensing agency as meeting the licensing standards, where applicable; and meets other conditions found by the Secretary of Health and Human Services to be necessary for health and safety. |
| Notes: Source: CFR42 Chapter IV Part 484, http://www.access.gpo.gov/nara/cfr/waisidx_99/42cfr484_99.html [7/1/2007: definition added, source added] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295347938 | Tender Care Helth Services, LLC | Home Health | 2138 Main St E, Snellville, GA 30078-3496 | 2020-08-22 |
| 1538786538 | Shana Burwell | Home Health | 3610 Jasmine Cove Ln, Snellville, GA 30039-8414 | 2020-06-25 |
| 1700439627 | All Angel Care,llc | Home Health | 2398 Lenora Church Rd Ste 102, Snellville, GA 30078-6921 | 2019-07-19 |
| 1255820007 | Bacchus Private Home Care LLC | Home Health | 4925 Bridle Point Parkway, Snellville, GA 30039 | 2018-05-08 |
| 1417453150 | Bridgeway Hha Metro, LLC | Home Health | 2351 Henry Clower Blvd Ste A, Snellville, GA 30078-7421 | 2018-04-02 |
| 1457869141 | Pride Healthcare Staffing LLC | Home Health | 3449 Allie Dr, Snellville, GA 30039-7105 | 2018-01-16 |
| 1730550179 | A-list Home Health Agency | Home Health | 1350 Scenic Hwy N Ste 215, Snellville, GA 30078-7907 | 2015-10-12 |
| 1588062343 | S2 Enterprises Inc | Home Health | 2795 W Main St Ste 24a, Snellville, GA 30078-3075 | 2014-12-10 |
| 1891104105 | Heavenly Health Care | Home Health | 3242 Glynn Mill Dr, None, Snellville, GA 30039-6235 | 2014-08-12 |
| 1003229667 | Eti Healthcare LLC | Home Health | 2170 Bankston Cir, Snellville, GA 30078-5718 | 2014-06-11 |
| Find all providers in SNELLVILLE | ||||
| City | SNELLVILLE |
| Zip Code | 30039 |
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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.