MEDICARE: ABC HEALTHCARE OF AMERICA, 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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1811400294
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABC HEALTHCARE OF AMERICA, LLC.

Provider Business Mailing Address
First Line	:	PO BOX 43686
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30336-0686
Country	:	US
Telephone Number	:	678-612-2395
Fax Number	:

Provider Business Practice Location Address
First Line	:	5532 OLD NATIONAL HWY BLDG G
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30349-3277
Country	:	US
Telephone Number	:	678-612-2395
Fax Number	:	404-973-0694

Authorized Official
Title or Position	:	DIRECTOR
Name	:	PHILOMENA WRIGHT
Credential	:	RN
Telephone Number	:	678-612-2395

Provider Enumeration Date	:	11/08/2017
Last Update Date	:	11/08/2017

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