=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134921166
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AVANTA CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/27/2025
-----------------------------------------------------
Last Update Date | 07/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 483 OAK DR
-----------------------------------------------------
City | HAPEVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30354-1228
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-464-6700
-----------------------------------------------------
Fax | 404-738-3377
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 483 OAK DR
-----------------------------------------------------
City | HAPEVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30354-1228
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MELISSA SIMMS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 404-464-6700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3104A0630X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility (Behavioral Disturbances)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------