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General NPI Number Information
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NPI Number | 1376151100
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Entity Type | Organization
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Legal Business Name | ADVENT CARE SYSTEMS HOME CARE OF OCILLA, LLC.
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Dates
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Enumeration Date | 07/17/2020
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Last Update Date | 08/05/2021
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Provider Practice Location Address
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Address Line | 501 N IRWIN AVE
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City | OCILLA
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State | GA
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Zip | 31774-5007
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Country | US
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Telephone | 229-468-0646
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Fax | 229-468-9300
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Provider Business Mailing Address
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Address Line | 501 N IRWIN AVE
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City | OCILLA
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State | GA
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Zip | 31774-5007
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Country | US
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Telephone | 912-532-9308
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Fax | 229-299-9697
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | RYAN TRETTIEN
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Credential |
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Telephone | 912-532-9308
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WH0200X
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Taxonomy Name | Home Health Registered Nurse
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251F00000X
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Taxonomy Name | Home Infusion Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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