# COLUMBUS GA HOMECARE, LLC

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

## Provider details

- **NPI number:** 1770040099
- **Authorized official:** MATT JOHNSON (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (706) 914-3960

## Contact information

- **Practice address:** 1501 13TH STREET., SUITE G, COLUMBUS, GA 31901
- **Practice address phone:** (706) 914-3960
- **Practice address fax:** (706) 914-3961
- **Mailing address:** 1501 13TH STREET., SUITE G, COLUMBUS, GA 31901
- **Mailing address phone:** (706) 914-3960
- **Mailing address fax:** (706) 914-3961

## Taxonomy

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

## Other

- **Enumeration date:** 02/22/2019
- **Last updated:** 02/22/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | PHCP010168 | PRIVATE HOMECARE PROVIDER | GA |