Healthcare Provider Details

I. General information

NPI: 1508638339
Provider Name (Legal Business Name): ANNIE'S HEALTHCARE, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2023
Last Update Date: 10/25/2023
Certification Date: 10/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

919 8TH AVE APT A
ALBANY GA
31701-0567
US

IV. Provider business mailing address

919 8TH AVE APT A
ALBANY GA
31701-0567
US

V. Phone/Fax

Practice location:
  • Phone: 229-894-4647
  • Fax:
Mailing address:
  • Phone: 229-894-4647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: TENESHA JONES
Title or Position: ADMINISTRATOR
Credential: LPN
Phone: 229-894-4647