=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447547013
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOME CARE ASSISTANCE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/05/2011
-----------------------------------------------------
Last Update Date | 07/05/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3168 PEACHTREE RD NW
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30305-1853
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-355-9901
-----------------------------------------------------
Fax | 404-467-8334
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3168 PEACHTREE RD NW
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30305-1853
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-355-9901
-----------------------------------------------------
Fax | 404-467-8334
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF CLIENT SERVICES
-----------------------------------------------------
Name | MS. TRIFFANY COOK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 404-355-9901
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number | 060-R-0155
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------