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General NPI Number Information
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NPI Number | 1811329915
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Entity Type | Organization
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Legal Business Name | MOSES HOME CARE AGENCY
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Dates
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Enumeration Date | 07/31/2013
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Last Update Date | 05/11/2015
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Provider Practice Location Address
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Address Line | 140 MOUNT VERNON RD
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City | FLOVILLA
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State | GA
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Zip | 30216-2305
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Country | US
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Telephone | 770-775-3366
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Fax | 770-775-6900
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Provider Business Mailing Address
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Address Line | 140 MT.VERNON RD
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City | FLOVILLA
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State | GA
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Zip | 30216-2305
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Country | US
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Telephone | 770-775-3366
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Fax | 770-775-6900
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Authorized Official
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Title or Position | OWNER/CEO
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Name | MOSES T ADAMS
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Credential |
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Telephone | 770-775-3366
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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 | 018-R0515
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License Number State | GA
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