Provider Demographics
NPI:1174921639
Name:AMICASA HOME CARE CORPORATION
Entity type:Organization
Organization Name:AMICASA HOME CARE CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO-ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:AFULUENU
Authorized Official - Last Name:AZIKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-537-1960
Mailing Address - Street 1:157 BURKE ST
Mailing Address - Street 2:SUITE 119
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-3433
Mailing Address - Country:US
Mailing Address - Phone:404-537-1960
Mailing Address - Fax:
Practice Address - Street 1:157 BURKE ST
Practice Address - Street 2:SUITE 119
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-3433
Practice Address - Country:US
Practice Address - Phone:404-537-1960
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMICASA HOME CARE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-12-16
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA075-R-0801251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA565352OtherTHE JOINT COMMISSION
GA003110469BOtherMEDICAID CCSP
GA003110469COtherMEDICAID SOURCE
GA003110469AMedicaid
GA111707Medicare Oscar/Certification