MEDICARE: HOME OR AWAY, 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	106-R-0580	GA
2	253Z00000X	In Home Supportive Care Agency	106-R-0580	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	106-R-0580	OTHER	GA	PRIVATE HOME CARE PROVIDER

General Provider Information

NPI Number	:	1295061471
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOME OR AWAY, LLC

Provider Business Mailing Address
First Line	:	1320 WYNNTON RD STE D
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31906-2867
Country	:	US
Telephone Number	:	706-561-1700
Fax Number	:	912-335-3534

Provider Business Practice Location Address
First Line	:	1320 WYNNTON RD STE D
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31906-2867
Country	:	US
Telephone Number	:	706-561-1700
Fax Number	:	912-335-3534

Authorized Official
Title or Position	:	CEO
Name	:	FELIX WIBERGH
Credential	:
Telephone Number	:	706-256-8672

Provider Enumeration Date	:	10/23/2009
Last Update Date	:	06/15/2026

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Directions to “HOME OR AWAY, LLC ” Practice Location

Language	Start Address	Practice Location

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