Provider Demographics
NPI:1881920700
Name:HOME CARE GEORGIA
Entity type:Organization
Organization Name:HOME CARE GEORGIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:MINICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-384-0494
Mailing Address - Street 1:1280 WINCHESTER PKWY SE STE 210
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-6548
Mailing Address - Country:US
Mailing Address - Phone:770-384-0494
Mailing Address - Fax:770-384-0093
Practice Address - Street 1:1280 WINCHESTER PKWY SE STE 210
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-6548
Practice Address - Country:US
Practice Address - Phone:770-384-0494
Practice Address - Fax:770-384-0093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-28
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA033R0079OtherPRIVATE HOME CARE PROVIDER AGENCY