MEDICARE: SENIOR CARE OF COLUMBUS

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	106-R-0035	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912100090
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SENIOR CARE OF COLUMBUS

Provider Business Mailing Address
First Line	:	6400 BRADLEY PARK DR
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-3615
Country	:	US
Telephone Number	:	706-507-0552
Fax Number	:

Provider Business Practice Location Address
First Line	:	6400 BRADLEY PARK DR
Second Line	:	SUITE A-1
City	:	COLUMBUS
State	:	GA
Zip	:	31904-3615
Country	:	US
Telephone Number	:	706-507-0552
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MS. DELLA UPSHAW
Credential	:
Telephone Number	:	706-464-2009

Provider Enumeration Date	:	06/07/2007
Last Update Date	:	03/17/2009

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Directions to “SENIOR CARE OF COLUMBUS ” Practice Location

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