Healthcare Provider Details

I. General information

NPI: 1346550670
Provider Name (Legal Business Name): CELESTIAL CARE COMPANIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2010
Last Update Date: 07/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1177 CONSTITUTION RD SE APT L4
ATLANTA GA
30315-6840
US

IV. Provider business mailing address

1177 CONSTITUTION RD SE APT L4
ATLANTA GA
30315-6840
US

V. Phone/Fax

Practice location:
  • Phone: 404-426-1028
  • Fax:
Mailing address:
  • Phone: 404-426-1028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number10039349
License Number StateGA

VIII. Authorized Official

Name: MS. CELESTE LAVERNE LOMAX
Title or Position: CEO/OFFICE MANAGER
Credential: CEO
Phone: 404-426-1028