Healthcare Provider Details

I. General information

NPI: 1447787973
Provider Name (Legal Business Name): BEYOND COMPANION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2017
Last Update Date: 09/11/2021
Certification Date: 09/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 PEACHTREE ST NE STE 570
ATLANTA GA
30308-1244
US

IV. Provider business mailing address

PO BOX 1338
CONLEY GA
30288-7020
US

V. Phone/Fax

Practice location:
  • Phone: 617-955-4385
  • Fax:
Mailing address:
  • Phone: 617-955-4385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number178200LGB
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number178200LGB
License Number StateGA

VIII. Authorized Official

Name: MISS CASSIE ULYSSE
Title or Position: OWNER
Credential: MSM
Phone: 617-955-4385