MEDICARE: A SPECIAL CARE SERVICE, 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	251J00000X	Nursing Care Agency		GA

General Provider Information

NPI Number	:	1700928710
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A SPECIAL CARE SERVICE, INC.

Provider Business Mailing Address
First Line	:	P.O. BOX 960852
Second Line	:
City	:	RIVERDALE
State	:	GA
Zip	:	30296-0852
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10647 SANDPIPER RD.
Second Line	:
City	:	JONESBORO
State	:	GA
Zip	:	30238-6658
Country	:	US
Telephone Number	:	770-572-8465
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE
Name	:	MRS. ARVA CHARLENE FOSTER
Credential	:
Telephone Number	:	770-572-8465

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	09/29/2008

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