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General NPI Number Information
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NPI Number | 1417191768
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Entity Type | Organization
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Legal Business Name | REST ASSURED HOME CARE, LLC
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Dates
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Enumeration Date | 04/29/2009
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Last Update Date | 04/29/2009
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Provider Practice Location Address
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Address Line | 208 PITCARIN WAY STE C
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City | AUGUSTA
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State | GA
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Zip | 30909-5766
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Country | US
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Telephone | 706-868-7161
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Fax | 706-868-7210
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Provider Business Mailing Address
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Address Line | 101 RICE BENT WAY STE 8
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City | COLUMBIA
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State | SC
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Zip | 29229-6850
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Country | US
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Telephone | 803-865-8113
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Fax | 803-865-8173
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Authorized Official
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Title or Position | DIRECTOR
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Name | REATHA JOHNSON
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Credential | RN
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Telephone | 803-865-8113
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 126730
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License Number State | GA
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