Organization
COLUMBUS GA HOMECARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATT JOHNSON (EXECUTIVE DIRECTOR)
(706) 914-3960
Entity
Organization
Contact information
Practice address
1501 13TH STREET., SUITE G, COLUMBUS, GA 31901
(706) 914-3960
(706) 914-3961
Mailing address
1501 13TH STREET., SUITE G, COLUMBUS, GA 31901
(706) 914-3960
(706) 914-3961
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PHCP010168
PRIVATE HOMECARE PROVIDER
GA
Enumeration date
02/22/2019
Last updated
02/22/2019
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