=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194840728
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | APPLIED HOME CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/20/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3758 LAVISTA RD SUITE 200
-----------------------------------------------------
City | TUCKER
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30084-5620
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-320-3272
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3758 LAVISTA RD SUITE 200
-----------------------------------------------------
City | TUCKER
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30084-5260
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-320-3272
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | CHERYL ROGERS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 404-320-3272
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 251E00000X
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------