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General NPI Number Information
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NPI Number | 1417199662
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Entity Type | Organization
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Legal Business Name | SPERITY HOME HEALTH SERVICES LLC
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Dates
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Enumeration Date | 04/02/2009
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Last Update Date | 04/02/2009
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Provider Practice Location Address
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Address Line | 305 GLADSTONE DR
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City | MCDONOUGH
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State | GA
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Zip | 30253-8097
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Country | US
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Telephone | 678-651-8990
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 960898
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City | RIVERDALE
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State | GA
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Zip | 30296-0898
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Country | US
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Telephone | 678-651-8990
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MRS. AZUKA EZUMEZU
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Credential |
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Telephone | 678-651-8990
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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 | 000111
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License Number State | GA
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