Healthcare Provider Details

I. General information

NPI: 1982940151
Provider Name (Legal Business Name): SECURE CARE AUGUSTA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2012
Last Update Date: 06/03/2020
Certification Date: 06/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 MONTE SANO AVE
AUGUSTA GA
30904-7808
US

IV. Provider business mailing address

1520 MONTE SANO AVE
AUGUSTA GA
30904-7808
US

V. Phone/Fax

Practice location:
  • Phone: 706-993-9271
  • Fax: 706-863-5638
Mailing address:
  • Phone: 706-993-9271
  • Fax: 706-863-5638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: TARA LEGRAND LUNDY
Title or Position: BILLING MANAGEMENT
Credential:
Phone: 706-723-9926