Healthcare Provider Details

I. General information

NPI: 1760247563
Provider Name (Legal Business Name): LUXURY HEALING HOUSE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2024
Last Update Date: 02/20/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2274 SALEM RD SE STE 1061720
CONYERS GA
30013-2097
US

IV. Provider business mailing address

2274 SALEM RD SE STE 1061720
CONYERS GA
30013-2097
US

V. Phone/Fax

Practice location:
  • Phone: 470-260-4623
  • Fax:
Mailing address:
  • Phone: 470-260-4623
  • 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 Code261QR0800X
TaxonomyRecovery Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. SANTANA SIMS
Title or Position: OWNER
Credential: BSN, RN
Phone: 470-260-4623