Healthcare Provider Details

I. General information

NPI: 1992554422
Provider Name (Legal Business Name): EVERLASTING LIFE SENIOR CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2024
Last Update Date: 05/16/2024
Certification Date: 05/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4519 BRONTE LN
DOUGLASVILLE GA
30135-4967
US

IV. Provider business mailing address

PO BOX 5124
DOUGLASVILLE GA
30154-0003
US

V. Phone/Fax

Practice location:
  • Phone: 770-262-0319
  • Fax:
Mailing address:
  • Phone: 770-262-0319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: MS. DELIA BARKSDALE
Title or Position: CEO
Credential:
Phone: 770-262-0319