MEDICARE: NURSE 2 HEALTH HOME CARE 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	110-R-1550	GA

General Provider Information

NPI Number	:	1790231439
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NURSE 2 HEALTH HOME CARE LLC

Provider Business Mailing Address
First Line	:	66 BROOKVALLEY COMMONS DRIVE
Second Line	:
City	:	DALLAS
State	:	GA
Zip	:	30157
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1075 PEACHTREE STREET NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30309
Country	:	US
Telephone Number	:	404-965-3976
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	AMBER FOSTER
Credential	:
Telephone Number	:	404-965-3976

Provider Enumeration Date	:	09/01/2016
Last Update Date	:	09/01/2016

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