MEDICARE: PUBLIC HEALTH PERSONAL SUPPORT SERVICES, INC.

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	092-R-002	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255345534
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PUBLIC HEALTH PERSONAL SUPPORT SERVICES, INC.

Provider Business Mailing Address
First Line	:	PO BOX 3284
Second Line	:
City	:	VALDOSTA
State	:	GA
Zip	:	31604-3284
Country	:	US
Telephone Number	:	229-253-1164
Fax Number	:	229-253-1151

Provider Business Practice Location Address
First Line	:	1811 GREEN CIR
Second Line	:
City	:	VALDOSTA
State	:	GA
Zip	:	31602-2734
Country	:	US
Telephone Number	:	229-253-1164
Fax Number	:	229-253-1151

Authorized Official
Title or Position	:	CEO
Name	:	MRS. DENISE RETTERBUSH
Credential	:	RN
Telephone Number	:	229-253-1067

Provider Enumeration Date	:	07/29/2006
Last Update Date	:	08/10/2023

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