=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578179313
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STANDARD HOMECARE OF AUGUSTA,LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/17/2020
-----------------------------------------------------
Last Update Date | 09/17/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4583 COLDWATER ST
-----------------------------------------------------
City | GROVETOWN
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30813-4065
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-597-2765
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4583 COLDWATER ST
-----------------------------------------------------
City | GROVETOWN
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30813-4065
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-597-2765
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | RN
-----------------------------------------------------
Name | RHONDA A. CALVIN
-----------------------------------------------------
Credential | ADM.
-----------------------------------------------------
Telephone | 703-597-2765
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251J00000X
-----------------------------------------------------
Taxonomy Name | Nursing Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------