Healthcare Provider Details

I. General information

NPI: 1033711098
Provider Name (Legal Business Name): MEB LIFE HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2020
Last Update Date: 02/23/2022
Certification Date: 02/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1238 2ND AVE STE 6
COLUMBUS GA
31901-5241
US

IV. Provider business mailing address

1238 2ND AVE STE 6
COLUMBUS GA
31901-5241
US

V. Phone/Fax

Practice location:
  • Phone: 334-614-8275
  • Fax:
Mailing address:
  • Phone: 334-614-8275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: LATONIA DAVIS
Title or Position: ADMINISTRATOR
Credential:
Phone: 334-614-8275