MEDICARE: PERMANENCY STEPS CONSULTING FIRM, 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	251B00000X	Case Management Agency	CSW000573	GA
2	251X00000X	Supports Brokerage Agency
3	347C00000X	Private Vehicle
4	347E00000X	Transportation Broker
5	252Y00000X	Early Intervention Provider Agency	CSW000573	GA
6	251S00000X	Community/Behavioral Health Agency	CSW000573	GA

General Provider Information

NPI Number	:	1548530058
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERMANENCY STEPS CONSULTING FIRM, LLC

Provider Business Mailing Address
First Line	:	PO BOX 960424
Second Line	:
City	:	RIVERDALE
State	:	GA
Zip	:	30296-0424
Country	:	US
Telephone Number	:	404-323-6198
Fax Number	:	770-472-7890

Provider Business Practice Location Address
First Line	:	136 HIGHWAY 138 SW
Second Line	:	SUITE 200
City	:	RIVERDALE
State	:	GA
Zip	:	30274-4008
Country	:	US
Telephone Number	:	404-323-6198
Fax Number	:	770-472-7890

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	IVIS RENEE KING
Credential	:	MSW
Telephone Number	:	404-323-6198

Provider Enumeration Date	:	01/01/2012
Last Update Date	:	01/12/2012

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