MEDICARE: PM HOME CARE SERVICES 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1114543006
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PM HOME CARE SERVICES LLC

Provider Business Mailing Address
First Line	:	3144 WISTERIA WAY
Second Line	:
City	:	EAST POINT
State	:	GA
Zip	:	30344-5328
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3144 WISTERIA WAY
Second Line	:
City	:	EAST POINT
State	:	GA
Zip	:	30344-5328
Country	:	US
Telephone Number	:	404-626-2946
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TELICIA GOBER
Credential	:
Telephone Number	:	404-626-2946

Provider Enumeration Date	:	06/17/2020
Last Update Date	:	06/17/2020

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