MEDICARE: AMICITA HOME HEALTH 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	019224	GA
2	251E00000X	Home Health Agency	019-224	GA

General Provider Information

NPI Number	:	1730168865
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMICITA HOME HEALTH LLC

Provider Business Mailing Address
First Line	:	806 MAPLE DR
Second Line	:
City	:	VIDALIA
State	:	GA
Zip	:	30474-7208
Country	:	US
Telephone Number	:	912-538-8000
Fax Number	:	912-538-0467

Provider Business Practice Location Address
First Line	:	507 N JEFFERSON ST
Second Line	:
City	:	ALBANY
State	:	GA
Zip	:	31701-2354
Country	:	US
Telephone Number	:	229-725-3500
Fax Number	:	229-725-2700

Authorized Official
Title or Position	:	VICE PRESIDENT OF OPERATIONS
Name	:	MRS. SARAH A THOMPSON
Credential	:	RN, CHPN
Telephone Number	:	912-538-8000

Provider Enumeration Date	:	01/17/2006
Last Update Date	:	02/22/2017

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Directions to “AMICITA HOME HEALTH LLC ” Practice Location

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