MEDICARE: AMORE COMMUNITY SERVICES INC

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	251S00000X	Community/Behavioral Health Agency	1501022172	GA

General Provider Information

NPI Number	:	1528407368
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMORE COMMUNITY SERVICES INC

Provider Business Mailing Address
First Line	:	3720 NEWHALEM STREET S.W.
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331
Country	:	US
Telephone Number	:	404-344-3074
Fax Number	:	404-344-3094

Provider Business Practice Location Address
First Line	:	3720 NEWHALEM ST SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-2243
Country	:	US
Telephone Number	:	404-344-3074
Fax Number	:	404-344-3094

Authorized Official
Title or Position	:	RESIDENTIAL CARE MANAGER
Name	:	MS. JACQUELINE ANN GIBSON
Credential	:
Telephone Number	:	404-344-3074

Provider Enumeration Date	:	06/14/2013
Last Update Date	:	06/14/2013

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