Organization
AMICASA HOME CARE CORPORATION
Active
Parent organization
031-0344-H
Other names
Amicasa Home Care and Hospice
Organization subpart
Yes
Provider details
NPI number
Legal business name
031-0344-H
Authorized official
EVELYN A. AZIKE RN, MSN, CWOCN (ADMINISTRATOR-CEO)
(404) 537-1960
Entity
Organization
Contact information
Practice address
157 BURKE STREET, SUITE 119, STOCKBRIDGE, GA 30281-3439
(404) 537-1960
(404) 935-9334
Mailing address
157 BURKE STREET, SUITE 119, STOCKBRIDGE, GA 30281-3439
(404) 537-1960
(404) 935-9334
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
075-R-0801
GA
251G00000X
Community Based Hospice Care Agency
Primary
031-0344-H
GA
251J00000X
Nursing Care Agency
075-R-0801
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003110469A
—
GA
01
—
003110469B
MEDICAID CCSP
GA
01
—
031-0344-H
STATE OF GEORGIA PERMIT
GA
01
—
075-R-0801
NURSING
GA
01
—
565352
JOINT COMMISSION
GA
Enumeration date
06/08/2010
Last updated
01/05/2016
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