MEDICARE: INDEPENDENCE CARE OF GEORGIA LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251S00000X	Community/Behavioral Health Agency
2	251E00000X	Home Health Agency
3	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care
4	253Z00000X	In Home Supportive Care Agency
5	385H00000X	Respite Care
6	385HR2055X	Child Mental Illness Respite Care

General Provider Information

NPI Number	:	1659072601
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDEPENDENCE CARE OF GEORGIA LLC

Provider Business Mailing Address
First Line	:	3301 BONITA BEACH RD STE 208
Second Line	:
City	:	BONITA SPRINGS
State	:	FL
Zip	:	34134-7835
Country	:	US
Telephone Number	:	845-559-3081
Fax Number	:

Provider Business Practice Location Address
First Line	:	235 N BELAIR RD STE 207
Second Line	:
City	:	EVANS
State	:	GA
Zip	:	30809-3357
Country	:	US
Telephone Number	:	845-559-3081
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ALLISON VIAR
Credential	:
Telephone Number	:	917-733-1135

Provider Enumeration Date	:	03/16/2023
Last Update Date	:	05/28/2026

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