Healthcare Provider Details

I. General information

NPI: 1821796723
Provider Name (Legal Business Name): LOVING HANDS EXTENDED HOME SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2023
Last Update Date: 02/20/2023
Certification Date: 02/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1906 DAWSON RD STE 2
ALBANY GA
31707-3306
US

IV. Provider business mailing address

1906 DAWSON RD STE 2
ALBANY GA
31707-3306
US

V. Phone/Fax

Practice location:
  • Phone: 229-434-1372
  • Fax: 229-434-0382
Mailing address:
  • Phone: 229-434-1372
  • Fax: 229-434-0382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
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 TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: PEGGY DIANE BOZEMAN
Title or Position: NURSE ADMINISTRATOR
Credential: PEGGY BOZEMAN, RNC
Phone: 229-434-1372