Healthcare Provider Details

I. General information

NPI: 1073234134
Provider Name (Legal Business Name): LEMON JUICE HEALTHCARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2022
Last Update Date: 09/14/2023
Certification Date: 12/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1980 PADGETT DR
AUSTELL GA
30106-1864
US

IV. Provider business mailing address

2817 JAMES HENRY DR
DACULA GA
30019-7553
US

V. Phone/Fax

Practice location:
  • Phone: 404-542-6450
  • Fax:
Mailing address:
  • Phone: 404-542-6450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: VONITA ISIDORE
Title or Position: CNA/MED TECH/PROXY CARE-CEOO
Credential:
Phone: 404-227-1257