MEDICARE: CPG PRIVATE HOME CARE PROVIDERS, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251E00000X	Home Health Agency
2	251J00000X	Nursing Care Agency
3	385H00000X	Respite Care
4	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1902407901
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CPG PRIVATE HOME CARE PROVIDERS, LLC

Provider Business Mailing Address
First Line	:	7787 CLEARVIEW CIR
Second Line	:
City	:	RIVERDALE
State	:	GA
Zip	:	30296-3383
Country	:	US
Telephone Number	:	770-875-1522
Fax Number	:

Provider Business Practice Location Address
First Line	:	238 STOCKBRIDGE RD STE 215
Second Line	:
City	:	JONESBORO
State	:	GA
Zip	:	30236-3629
Country	:	US
Telephone Number	:	770-492-2903
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PARTNER/CFO & ADMINISTRATOR
Name	:	PAMELA L CURRY
Credential	:
Telephone Number	:	770-875-1522

Provider Enumeration Date	:	11/05/2020
Last Update Date	:	11/05/2020

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