=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730061904
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AZALEA HOME CARE, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/21/2025
-----------------------------------------------------
Last Update Date | 07/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3545 CRUSE RD STE 309F3545
-----------------------------------------------------
City | LAWRENCEVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30044-3170
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-491-7122
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3545 CRUSE RD STE 309F
-----------------------------------------------------
City | LAWRENCEVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30044-3162
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-491-7122
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/OWNER
-----------------------------------------------------
Name | ANISH PATEL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 770-846-8496
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------