Provider Demographics
NPI:1730168865
Name:AMICITA HOME HEALTH LLC
Entity type:Organization
Organization Name:AMICITA HOME HEALTH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT 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:RN, CHPN
Authorized Official - Phone:912-538-8000
Mailing Address - Street 1:806 MAPLE DR
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 1:507 N JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-2354
Practice Address - Country:US
Practice Address - Phone:229-725-3500
Practice Address - Fax:229-725-2700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-17
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA019224251E00000X
GA019-224251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA117147Medicare PIN