MEDICARE: HOME HEALTH CARE SERVICES 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	550001546	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	550001546	OTHER	CA	STATE LICENSE

General Provider Information

NPI Number	:	1922472877
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOME HEALTH CARE SERVICES LLC

Provider Business Mailing Address
First Line	:	PO BOX 200
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30903-0200
Country	:	US
Telephone Number	:	706-303-5500
Fax Number	:	706-228-6808

Provider Business Practice Location Address
First Line	:	1590 OAKLAND RD
Second Line	:	STE B114
City	:	SAN JOSE
State	:	CA
Zip	:	95131-2443
Country	:	US
Telephone Number	:	408-437-3045
Fax Number	:	408-693-3742

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. RICK W GRIFFIN
Credential	:
Telephone Number	:	706-303-5500

Provider Enumeration Date	:	11/16/2015
Last Update Date	:	11/16/2015

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