MEDICARE: ALBANY PROFESSIONAL HEALTH CARE, LLC

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	253Z00000X	In Home Supportive Care Agency	047R0640	GA

General Provider Information

NPI Number	:	1033446620
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALBANY PROFESSIONAL HEALTH CARE, LLC

Provider Business Mailing Address
First Line	:	1216 DAWSON RD STE 221
Second Line	:
City	:	ALBANY
State	:	GA
Zip	:	31707-3867
Country	:	US
Telephone Number	:	229-883-1998
Fax Number	:

Provider Business Practice Location Address
First Line	:	1216 DAWSON RD, STE 221
Second Line	:
City	:	ALBANY
State	:	GA
Zip	:	31707-3867
Country	:	US
Telephone Number	:	229-883-1998
Fax Number	:

Authorized Official
Title or Position	:	CO-ADMINISTRATOR
Name	:	MS. SHERRY HOLMAN
Credential	:	RN
Telephone Number	:	229-883-1998

Provider Enumeration Date	:	11/03/2009
Last Update Date	:	11/03/2009

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