MEDICARE: GUPPY AGAIN, 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	056-R-0241	GA

General Provider Information

NPI Number	:	1558518704
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GUPPY AGAIN, INC

Provider Business Mailing Address
First Line	:	40 EASTBROOK BND STE B
Second Line	:
City	:	PEACHTREE CITY
State	:	GA
Zip	:	30269-1567
Country	:	US
Telephone Number	:	770-487-1297
Fax Number	:	770-487-1299

Provider Business Practice Location Address
First Line	:	40 EASTBROOK BND STE B
Second Line	:
City	:	PEACHTREE CITY
State	:	GA
Zip	:	30269-1567
Country	:	US
Telephone Number	:	770-487-1297
Fax Number	:	770-487-1299

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	LINDA PIROG
Credential	:
Telephone Number	:	770-487-1297

Provider Enumeration Date	:	08/19/2008
Last Update Date	:	08/19/2008

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