=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407044084
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOME SWEET HOME CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/09/2007
-----------------------------------------------------
Last Update Date | 10/09/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3970 RODNOR FOREST LN
-----------------------------------------------------
City | ALBANY
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31721-4414
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 229-430-8083
-----------------------------------------------------
Fax | 229-430-8237
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3970 RODNOR FOREST LN
-----------------------------------------------------
City | ALBANY
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31721-4414
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 229-430-8083
-----------------------------------------------------
Fax | 229-430-8237
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MR. BRYAN DEMETRIUS STRAIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 229-881-2258
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 047-R-0365
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------