MEDICARE: ESSENTIAL HOMECARE PROVIDER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency
2	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1366372260
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ESSENTIAL HOMECARE PROVIDER LLC

Provider Business Mailing Address
First Line	:	725 MCWILLIAMS RD SE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30315-8607
Country	:	US
Telephone Number	:	470-202-2772
Fax Number	:	470-625-3366

Provider Business Practice Location Address
First Line	:	725 MCWILLIAMS RD SE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30315-8607
Country	:	US
Telephone Number	:	470-202-2772
Fax Number	:	470-625-3366

Authorized Official
Title or Position	:	OWNER
Name	:	MR. SHEVAN OBRIAN HOWARD
Credential	:	PHD
Telephone Number	:	470-202-2772

Provider Enumeration Date	:	05/21/2026
Last Update Date	:	05/21/2026

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