MEDICARE: A SUPERIOR CHOICE MEDICAL STAFFING 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	251E00000X	Home Health Agency	060-R-0154	GA
2	253Z00000X	In Home Supportive Care Agency	060-R-0154	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629468392
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A SUPERIOR CHOICE MEDICAL STAFFING LLC

Provider Business Mailing Address
First Line	:	5881 GLENRIDGE DR
Second Line	:	SUITE 140
City	:	ATLANTA
State	:	GA
Zip	:	30328-5301
Country	:	US
Telephone Number	:	404-257-1608
Fax Number	:	404-257-1609

Provider Business Practice Location Address
First Line	:	5881 GLENRIDGE DR
Second Line	:	SUITE 140
City	:	ATLANTA
State	:	GA
Zip	:	30328-5301
Country	:	US
Telephone Number	:	404-257-1608
Fax Number	:	404-257-1609

Authorized Official
Title or Position	:	CEO
Name	:	MR. BRIAN LACEY
Credential	:
Telephone Number	:	678-464-1397

Provider Enumeration Date	:	02/02/2015
Last Update Date	:	06/12/2015

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