=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851948251
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SISTERCARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/20/2019
-----------------------------------------------------
Last Update Date | 08/20/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5471 MEMORIAL DR STE J1
-----------------------------------------------------
City | STONE MOUNTAIN
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30083-3241
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-734-0860
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 125
-----------------------------------------------------
City | SNELLVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30078-0125
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-734-0860
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MRS. ALLYSON H MOSES
-----------------------------------------------------
Credential | AO
-----------------------------------------------------
Telephone | 404-734-0860
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------