MEDICARE: INSTRUCTIVE VISITING NURSE SERVICE, 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	251S00000X	Community/Behavioral Health Agency	RN163373	GA
2	253Z00000X	In Home Supportive Care Agency	RN163373	GA
3	251J00000X	Nursing Care Agency	RN163373	GA

General Provider Information

NPI Number	:	1235571324
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INSTRUCTIVE VISITING NURSE SERVICE, LLC

Provider Business Mailing Address
First Line	:	PO BOX 258
Second Line	:
City	:	MORROW
State	:	GA
Zip	:	30260-0258
Country	:	US
Telephone Number	:	404-664-6183
Fax Number	:

Provider Business Practice Location Address
First Line	:	6728 CHESEPEAKE TRL
Second Line	:
City	:	REX
State	:	GA
Zip	:	30273-2229
Country	:	US
Telephone Number	:	404-664-6183
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	ALCENIA COLEMAN
Credential	:	RN
Telephone Number	:	404-664-6183

Provider Enumeration Date	:	07/18/2013
Last Update Date	:	07/18/2013

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