Healthcare Provider Details

I. General information

NPI: 1770031478
Provider Name (Legal Business Name): NORTHWEST GA HOME CARE/ DBA RIGHT AT HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2016
Last Update Date: 06/08/2023
Certification Date: 06/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 JOHN DAVENPORT DR NW SUITE B
ROME GA
30165-2535
US

IV. Provider business mailing address

11 JOHN DAVENPORT DR NW SUITE B
ROME GA
30165-2535
US

V. Phone/Fax

Practice location:
  • Phone: 706-290-7701
  • Fax: 706-290-7702
Mailing address:
  • Phone: 706-290-7701
  • Fax: 706-290-7702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number057-R-0017
License Number StateGA

VIII. Authorized Official

Name: MR. JAY DEVILLE
Title or Position: OWNER
Credential:
Phone: 706-290-7701