Healthcare Provider Details

I. General information

NPI: 1447569173
Provider Name (Legal Business Name): AMICUS HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2010
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3469 LAWRENCEVILLE HWY STE 304
TUCKER GA
30084-5890
US

IV. Provider business mailing address

3469 LAWRENCEVILLE HWY STE 304
TUCKER GA
30084-5890
US

V. Phone/Fax

Practice location:
  • Phone: 770-939-0146
  • Fax: 770-939-0145
Mailing address:
  • Phone: 770-939-0146
  • Fax: 770-939-0145

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 Code251J00000X
TaxonomyNursing Care Agency
License Number122-R-0514
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number122-R-0514
License Number StateGA

VIII. Authorized Official

Name: MR. OSARETIN ISIBOR
Title or Position: CEO
Credential:
Phone: 770-939-0146