MEDICARE: GEORGIA CARE AT HOME

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

General Provider Information

NPI Number	:	1700415189
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEORGIA CARE AT HOME

Provider Business Mailing Address
First Line	:	623 PETERS ST
Second Line	:
City	:	CALHOUN
State	:	GA
Zip	:	30701-3135
Country	:	US
Telephone Number	:	706-280-6206
Fax Number	:

Provider Business Practice Location Address
First Line	:	717 S WALL ST STE C
Second Line	:
City	:	CALHOUN
State	:	GA
Zip	:	30701-2649
Country	:	US
Telephone Number	:	706-280-6206
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	LAUREN ELISA BETH DEPERRO
Credential	:
Telephone Number	:	706-280-6206

Provider Enumeration Date	:	04/07/2020
Last Update Date	:	04/07/2020

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Directions to “GEORGIA CARE AT HOME ” Practice Location

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