Healthcare Provider Details

I. General information

NPI: 1245807676
Provider Name (Legal Business Name): RELYANCE HOME CARE SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2021
Last Update Date: 06/09/2021
Certification Date: 06/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 W RAILROAD ST S
PELHAM GA
31779-1631
US

IV. Provider business mailing address

530 THOMAS AVE
CAMILLA GA
31730-2318
US

V. Phone/Fax

Practice location:
  • Phone: 229-854-8497
  • Fax:
Mailing address:
  • Phone: 229-854-8497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3140N1450X
TaxonomyPediatric Skilled Nursing Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: AKINA S DAVIS
Title or Position: ADMINISTRATOR/OWNER
Credential:
Phone: 229-854-8497