# MEDICREST HOME CARE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1376880492
- **Authorized official:** TOVA E NIEVES (ADMINISTRATOR)
- **Authorized official phone:** (404) 946-3313

## Contact information

- **Practice address:** 15 JONESBORO ST, SUITE REAR, MCDONOUGH, GA 30253-3161
- **Practice address phone:** (404) 946-3313
- **Mailing address:** 15 JONESBORO ST, SUITE REAR, MCDONOUGH, GA 30253-3161
- **Mailing address phone:** (404) 946-3313

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 253Z00000X | In Home Supportive Care Agency | 075R0965 | GA | Yes |

## Other

- **Enumeration date:** 01/09/2013
- **Last updated:** 01/09/2013