MEDICARE: RELIABLE HOMECARE OF GEORGIA,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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	049183634	OTHER		DRIVERS LICENSE

General Provider Information

NPI Number	:	1285135657
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RELIABLE HOMECARE OF GEORGIA,LLC

Provider Business Mailing Address
First Line	:	4480 WORTHINGS CT
Second Line	:
City	:	POWDER SPRINGS
State	:	GA
Zip	:	30127-1471
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4480 WORTHINGS CT
Second Line	:
City	:	POWDER SPRINGS
State	:	GA
Zip	:	30127-1471
Country	:	US
Telephone Number	:	770-256-9161
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JOACHIM NWAGWU
Credential	:
Telephone Number	:	770-256-9161

Provider Enumeration Date	:	02/21/2018
Last Update Date	:	02/21/2018

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