Healthcare Provider Details

I. General information

NPI: 1346518396
Provider Name (Legal Business Name): BRANCHING BEYOND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2011
Last Update Date: 12/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 PERIMETER CTR N SUITE 300
ATLANTA GA
30346-3402
US

IV. Provider business mailing address

303 PERIMETER CTR N SUITE 300
ATLANTA GA
30346-3402
US

V. Phone/Fax

Practice location:
  • Phone: 678-690-8544
  • Fax: 678-400-0139
Mailing address:
  • Phone: 678-690-8544
  • Fax: 678-400-0139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number060-R-0713
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number060-R-0713
License Number StateGA

VIII. Authorized Official

Name: MRS. LUVARA PRUDHOMME MCCOREY
Title or Position: CEO
Credential:
Phone: 678-690-8544