1St Gwinnett Home Care LLC

Primary specialty

In Home Supportive Care AgencyTaxonomy code 253Z00000X

Legal business name

1ST GWINNETT HOME CARE LLC

Practice address

3570 E 18TH St BLDG 10123
Antioch, CA 94509-7450

Phone

(678) 913-6977

NPI assigned

Apr 9, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Samuel Bimbo

Title

Co-Owner

Phone

(678) 913-6977

Specialties & licenses 1

Addresses

Other names 1

• 1st GWINNETT HOME CARE LLC Other name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1712620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712707200000",
    "number": "1811740889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3570 E 18TH ST BLDG 10123",
            "city": "ANTIOCH",
            "state": "CA",
            "postal_code": "945097450",
            "telephone_number": "678-913-6977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3570 E 18TH ST BLDG 10123",
            "city": "ANTIOCH",
            "state": "CA",
            "postal_code": "945097450",
            "telephone_number": "678-913-6977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "1ST GWINNETT HOME CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-09",
        "last_updated": "2024-04-10",
        "certification_date": "2024-04-10",
        "status": "A",
        "authorized_official_last_name": "BIMBO",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "678-913-6977"
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "1st GWINNETT HOME CARE LLC",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "1st GWINNETT HOME CARE LLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• In Home Supportive Care Agency in Antioch, CA
• Providers in Antioch, CA by specialty
• In Home Supportive Care Agency in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.