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General NPI Number Information
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NPI Number | 1851461735
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Entity Type | Organization
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Legal Business Name | AMICITA HOME HEALTH, LLC
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 03/23/2017
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Provider Practice Location Address
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Address Line | 806 MAPLE DR
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City | VIDALIA
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State | GA
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Zip | 30474-7208
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Country | US
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Telephone | 912-538-8000
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Fax | 912-538-8000
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Provider Business Mailing Address
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Address Line | 806 MAPLE DRIVE
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City | VIDALIA
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State | GA
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Zip | 30474-7208
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Country | US
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Telephone | 912-538-8000
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Fax | 912-538-0467
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Authorized Official
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Title or Position | VP OF OPERATIONS
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Name | MRS. SARAH A THOMPSON
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Credential |
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Telephone | 912-538-8000
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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 | 132-013
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License Number State | GA
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