Healthcare Provider Details

I. General information

NPI: 1245695683
Provider Name (Legal Business Name): AMERICAN HOME CARE SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2015
Last Update Date: 02/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1682 BRUMBY CIR
LITHIA SPRINGS GA
30122-3958
US

IV. Provider business mailing address

1682 BRUMBY CIR
LITHIA SPRINGS GA
30122-3958
US

V. Phone/Fax

Practice location:
  • Phone: 404-401-0332
  • Fax: 770-234-5240
Mailing address:
  • Phone: 404-401-0332
  • Fax: 770-234-5240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number048-R-0967
License Number StateGA

VII. Legacy identifiers

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

# 1
Identifier003136148C
Identifier TypeMEDICAID
Identifier StateGA
Identifier Issuer

VIII. Authorized Official

Name: MR. FELIX TONY NKWOCHA
Title or Position: ADMINISTRATOR
Credential:
Phone: 404-401-0332