Provider Demographics
NPI:1598157307
Name:SIERRA PRIVATE HOMECARE, INC.
Entity Type:Organization
Organization Name:SIERRA PRIVATE HOMECARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCCARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-532-0023
Mailing Address - Street 1:75 CINNAMON OAK CIRCLE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30016
Mailing Address - Country:US
Mailing Address - Phone:678-532-0023
Mailing Address - Fax:678-806-4258
Practice Address - Street 1:75 CINNAMON OAK CIRCLE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30016
Practice Address - Country:US
Practice Address - Phone:678-532-0023
Practice Address - Fax:678-806-4258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-03
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA107-R-1254372600000X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty