MEDICARE: INTERMED HEALTH CARE 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	251B00000X	Case Management Agency	044-R-0427	GA

General Provider Information

NPI Number	:	1386083020
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERMED HEALTH CARE SERVICES, INC.

Provider Business Mailing Address
First Line	:	PO BOX 767547
Second Line	:
City	:	ROSWELL
State	:	GA
Zip	:	30076-7547
Country	:	US
Telephone Number	:	770-455-3828
Fax Number	:	770-455-3828

Provider Business Practice Location Address
First Line	:	1770 OLD SPRING HOUSE LN STE 108
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30338-6213
Country	:	US
Telephone Number	:	770-455-3817
Fax Number	:	770-455-3828

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	OLGA BOTEZAT
Credential	:
Telephone Number	:	770-722-3565

Provider Enumeration Date	:	06/16/2013
Last Update Date	:	06/16/2013

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