Healthcare Provider Details

I. General information

NPI: 1336702208
Provider Name (Legal Business Name): HOME HEALTH CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2019
Last Update Date: 04/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

629 RONALD REAGAN DR STE 3C
EVANS GA
30809-7608
US

IV. Provider business mailing address

933 BROAD ST STE 301
AUGUSTA GA
30901-7222
US

V. Phone/Fax

Practice location:
  • Phone: 706-854-7428
  • Fax:
Mailing address:
  • Phone: 706-854-7428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JOHN M SOUTHERN
Title or Position: TREASURER
Credential:
Phone: 67-854-7428