Provider Demographics
NPI:1598062960
Name:ALEXIS PRIVATE HOME CARE, INC.
Entity Type:Organization
Organization Name:ALEXIS PRIVATE HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:USHER
Authorized Official - Middle Name:F
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-936-0293
Mailing Address - Street 1:211 DOLLY ST
Mailing Address - Street 2:P.O. BOX 2007
Mailing Address - City:GRAY
Mailing Address - State:GA
Mailing Address - Zip Code:31032-5336
Mailing Address - Country:US
Mailing Address - Phone:478-936-0293
Mailing Address - Fax:
Practice Address - Street 1:211 DOLLY ST
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:GA
Practice Address - Zip Code:31032-5336
Practice Address - Country:US
Practice Address - Phone:478-936-0293
Practice Address - Fax:478-986-0273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-22
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA084R0201253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA217881829AMedicaid