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General NPI Number Information
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NPI Number | 1598001075
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Entity Type | Organization
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Legal Business Name | KOSTA PRIVATE HOME CARE, LLC
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Dates
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Enumeration Date | 01/02/2013
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Last Update Date | 01/02/2013
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Provider Practice Location Address
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Address Line | 235 PEACHTREE ST NE STE 400
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City | ATLANTA
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State | GA
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Zip | 30303-1400
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Country | US
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Telephone | 404-814-3092
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Fax | 888-608-5705
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Provider Business Mailing Address
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Address Line | 235 PEACHTREE ST NE STE 400
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City | ATLANTA
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State | GA
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Zip | 30303-1400
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Country | US
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Telephone | 404-814-3092
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Fax | 888-608-5705
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Authorized Official
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Title or Position | CEO
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Name | MR. CHRISTOPHER BERNASKI
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Credential |
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Telephone | 404-814-3092
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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 | 060-R-1088
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License Number State | GA
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