MEDICARE: LIVING PRIVATE HOME CARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	385H00000X	Respite Care	0060R0065	GA

General Provider Information

NPI Number	:	1013290436
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIVING PRIVATE HOME CARE

Provider Business Mailing Address
First Line	:	3034 GRAND AVE SW
Second Line	:	N/A
City	:	ATLANTA
State	:	GA
Zip	:	30315-9020
Country	:	US
Telephone Number	:	404-518-0619
Fax Number	:	770-969-0694

Provider Business Practice Location Address
First Line	:	3034 GRAND AVE SW
Second Line	:	N/A
City	:	ATLANTA
State	:	GA
Zip	:	30315-9020
Country	:	US
Telephone Number	:	404-518-0619
Fax Number	:	770-964-0694

Authorized Official
Title or Position	:	PROGRAM DIRECTOR
Name	:	MS. NNENNA M. EKEKE
Credential	:	N/A
Telephone Number	:	404-518-0619

Provider Enumeration Date	:	09/21/2011
Last Update Date	:	09/21/2011

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Directions to “LIVING PRIVATE HOME CARE ” Practice Location

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