MEDICARE: NORTH GEORGIA SENIOR HOME CARE 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	069-R-0767	GA

General Provider Information

NPI Number	:	1376951178
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH GEORGIA SENIOR HOME CARE LLC

Provider Business Mailing Address
First Line	:	315 ALLEN ST
Second Line	:
City	:	CUMMING
State	:	GA
Zip	:	30040-2605
Country	:	US
Telephone Number	:	678-450-1777
Fax Number	:	678-450-1999

Provider Business Practice Location Address
First Line	:	315 ALLEN ST
Second Line	:
City	:	CUMMING
State	:	GA
Zip	:	30040-2605
Country	:	US
Telephone Number	:	678-450-1777
Fax Number	:	678-450-1999

Authorized Official
Title or Position	:	VICE PRESIDENT/OFFICE MANAGER
Name	:	STACEY VOSHALL
Credential	:
Telephone Number	:	678-450-1777

Provider Enumeration Date	:	07/24/2014
Last Update Date	:	07/24/2014

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