Provider Demographics
NPI:1851461735
Name:AMICITA HOME HEALTH, LLC
Entity Type:Organization
Organization Name:AMICITA HOME HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:A
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-538-8000
Mailing Address - Street 1:806 MAPLE DRIVE
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:GA
Mailing Address - Zip Code:30474-7208
Mailing Address - Country:US
Mailing Address - Phone:912-538-8000
Mailing Address - Fax:912-538-0467
Practice Address - Street 1:806 MAPLE DR
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474-7208
Practice Address - Country:US
Practice Address - Phone:912-538-8000
Practice Address - Fax:912-538-8000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA132-013251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
117054OtherMEDICARE HOME HEALTH
117054OtherMEDICARE HOME HEALTH
GA000186062AMedicaid