Provider Demographics
NPI:1427180744
Name:SOUTHWESTERN HOMECARE & MEDICAL SERVICES INC
Entity Type:Organization
Organization Name:SOUTHWESTERN HOMECARE & MEDICAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:ECHEBELEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-844-9975
Mailing Address - Street 1:411 LYNN LN
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31705-3695
Mailing Address - Country:US
Mailing Address - Phone:404-844-9975
Mailing Address - Fax:888-687-4829
Practice Address - Street 1:136 N MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-4266
Practice Address - Country:US
Practice Address - Phone:229-889-1598
Practice Address - Fax:229-888-3558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA047-R-0036251E00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA938442389 (A)(B)(C)Medicaid