1396065777 NPI number — AMICASA HOME CARE CORPORATION

Table of content: (NPI 1396065777)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396065777 NPI number — AMICASA HOME CARE CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMICASA HOME CARE CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
AMICASA HOME CARE AND HOSPICE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396065777
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/05/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
157 BURKE STREET
Provider Second Line Business Mailing Address:
SUITE 119
Provider Business Mailing Address City Name:
STOCKBRIDGE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30281-3439
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-537-1960
Provider Business Mailing Address Fax Number:
404-935-9334

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
157 BURKE STREET
Provider Second Line Business Practice Location Address:
SUITE 119
Provider Business Practice Location Address City Name:
STOCKBRIDGE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30281-3439
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-537-1960
Provider Business Practice Location Address Fax Number:
404-935-9334
Provider Enumeration Date:
06/08/2010

Additional Information

Authorized Official

Authorized Official Last Name:
AZIKE
Authorized Official First Name:
EVELYN
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
ADMINISTRATOR-CEO
Authorized Official Telephone Number:
404-537-1960

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  075-R-0801 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251G00000X , with the licence number: 031-0344-H , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251J00000X , with the licence number: 075-R-0801 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 003110469B . This is a "MEDICAID CCSP" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 565352 . This is a "JOINT COMMISSION" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 031-0344-H . This is a "STATE OF GEORGIA PERMIT" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 003110469A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 075-R-0801 . This is a "NURSING" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com