Provider Demographics
NPI:1396065777
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:ADMINISTRATOR-CEO
Authorized Official - Prefix:
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:A
Authorized Official - Last Name:AZIKE
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN, CWOCN
Authorized Official - Phone:404-537-1960
Mailing Address - Street 1:157 BURKE STREET
Mailing Address - Street 2:SUITE 119
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-3439
Mailing Address - Country:US
Mailing Address - Phone:404-537-1960
Mailing Address - Fax:404-935-9334
Practice Address - Street 1:157 BURKE STREET
Practice Address - Street 2:SUITE 119
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-3439
Practice Address - Country:US
Practice Address - Phone:404-537-1960
Practice Address - Fax:404-935-9334
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:031-0344-H
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-06-08
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA075-R-0801251J00000X, 251E00000X
GA031-0344-H251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
No251J00000XAgenciesNursing Care
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003110469BOtherMEDICAID CCSP
GA565352OtherJOINT COMMISSION
GA031-0344-HOtherSTATE OF GEORGIA PERMIT
GA003110469AMedicaid
GA075-R-0801OtherNURSING
GA111707Medicare PIN