MEDICARE: NEVAEHS CARE HOME 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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1902768948
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEVAEHS CARE HOME LLC

Provider Business Mailing Address
First Line	:	5201 BRENTWOOD RD
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30349-5801
Country	:	US
Telephone Number	:	404-980-6314
Fax Number	:

Provider Business Practice Location Address
First Line	:	5201 BRENTWOOD RD
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30349-5801
Country	:	US
Telephone Number	:	404-980-6314
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	FELICIA SMITH
Credential	:
Telephone Number	:	404-980-6314

Provider Enumeration Date	:	11/28/2025
Last Update Date	:	11/28/2025

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