Healthcare Provider Details

I. General information

NPI: 1396065777
Provider Name (Legal Business Name): AMICASA HOME CARE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2010
Last Update Date: 01/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 BURKE STREET SUITE 119
STOCKBRIDGE GA
30281-3439
US

IV. Provider business mailing address

157 BURKE STREET SUITE 119
STOCKBRIDGE GA
30281-3439
US

V. Phone/Fax

Practice location:
  • Phone: 404-537-1960
  • Fax: 404-935-9334
Mailing address:
  • Phone: 404-537-1960
  • Fax: 404-935-9334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number075-R-0801
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number031-0344-H
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number075-R-0801
License Number StateGA

VIII. Authorized Official

Name: EVELYN A. AZIKE
Title or Position: ADMINISTRATOR-CEO
Credential: RN, MSN, CWOCN
Phone: 404-537-1960