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General NPI Number Information
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NPI Number | 1619203395
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Entity Type | Organization
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Legal Business Name | INTERMED HOME CARE INCORPORATED
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Dates
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Enumeration Date | 10/30/2009
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1580 WARSAW RD
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City | ROSWELL
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State | GA
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Zip | 30076-1532
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Country | US
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Telephone | 770-455-3817
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Fax | 770-455-3828
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Provider Business Mailing Address
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Address Line | P.O. BOX 767547
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City | ROSWELL
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State | GA
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Zip | 30076
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Country | US
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Telephone | 770-455-3817
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Fax | 770-455-3828
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Authorized Official
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Title or Position | PRESIDENT
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Name | OLGA BOTEZAT
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Credential |
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Telephone | 770-722-3565
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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 | 044-R-0427
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License Number State | GA
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