Provider Demographics
NPI:1174058010
Name:CANOPY HOMECARE, LLC
Entity type:Organization
Organization Name:CANOPY HOMECARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:STAMEY-LUCAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-438-0033
Mailing Address - Street 1:2453 POWDER SPRINGS RD SW
Mailing Address - Street 2:SUITE 225
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-4570
Mailing Address - Country:US
Mailing Address - Phone:770-438-0033
Mailing Address - Fax:
Practice Address - Street 1:2453 POWDER SPRINGS RD SW
Practice Address - Street 2:SUITE 225
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-4570
Practice Address - Country:US
Practice Address - Phone:770-438-0033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-28
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care