Amicita Home Health LLC
Organization Active NPI Home Health Agency · Albany, GA
NPI 1730168865 · NPPES record last updated Feb 22, 2017
Key facts
- NPI
- 1730168865
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Home Health Agency 251E00000X
- License
- 019-224 (GA)
- Legal business name
- AMICITA HOME HEALTH LLC
- Practice address
- 507 N Jefferson St
Albany, GA 31701-2354 - Phone
- (229) 725-3500
- Fax
- (229) 725-2700
- NPI assigned
- Jan 17, 2006
- Organization subpart
- No
Authorized official
- Name
- Mrs. Sarah A Thompson, RN, CHPN
- Title
- Vice President of Operations
- Phone
- (912) 538-8000
Owners & managing parties with NPI records 1
Other NPIs with the same Medicare PAC ID 1
Corporate family (same tax ID) 1
Member of 1
Facilities with the same owner 11
Affiliated clinicians 2
-
Abdollatif Saleh Ghiathi, D.O.
Medicare Care Compare: Home health agency
- Listed as
- Chsga Home Health
- Overall star rating
- ★★★☆☆ 2.5 of 5
- Ownership
- Proprietary
- Certified
- Nov 16, 2005
- Medicare certification status
- Active
- Services
- Nursing, Medical social, Physical therapy, Speech pathology
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 11D1008401 | Amicita Home Health, LLC | Certificate of waiver | Jan 20, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Home health agency certification: CCN 117147
- Legal name
- AMICITA HOME HEALTH LLC
- Doing business as
- CHSGA HOME HEALTH
- Certification status
- Active
- Provider type (POS)
- Home health agency
- Participating since
- Nov 16, 2005
- Last certification
- Jul 12, 2017
- Ownership / control type
- Proprietary
- Organization structure
- LLC · Non-profit
- Incorporated
- Dec 29, 2009 in GA
- Enrollment address
- 507 N Jefferson St
Albany, GA 31701-2354
All disclosed owners & managing parties 4
| Name | Role | Since | Share |
|---|---|---|---|
| Home and Community Services Inc |
5% Or Greater Direct Ownership Interest | Jan 1, 2021 | 100% |
| Michael D Satchell |
Contracted Managing Employee |
Jul 1, 2019 | |
| Debbra D Gilbert |
Corporate Officer |
Feb 1, 2024 | 100% |
| W-2 Managing Employee |
Feb 1, 2024 | 100% | |
| Michelle Moore-Andrews |
Corporate Officer |
Oct 19, 2023 | 100% |
| W-2 Managing Employee |
Oct 19, 2023 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120907000138 | GA | Part a Provider - Home Health Agency | 3870618903 | Practice locations: Albany, GA |
National Provider Directory
- Tax ID family
- Amicita Home Health
Locations
101 Walton Way
Hazlehurst, GA 31539
Phone (912) 379-9914
167 W Orange St
Jesup, GA 31545
Phone (912) 427-8299
1 SW Broad St
Metter, GA 30439
Phone (912) 685-3834
53 Williams St
#B
Reidsville, GA 30453
Phone (912) 557-6787
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | 019224 | GA | |
| Home Health Agency | 251E00000X | 019-224 | GA | Yes |
Addresses
Primary practice location
507 N Jefferson St
Albany, GA 31701-2354
Mailing address
806 Maple Dr
Vidalia, GA 30474-7208
Phone (912) 538-8000
Other names
- Amicita Home Health
Other providers in Albany, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 22, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.