Healthcare Provider Details

I. General information

NPI: 1992313886
Provider Name (Legal Business Name): LA PAZ HOMECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2020
Last Update Date: 12/09/2021
Certification Date: 12/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6974 SPRINGWOOD DR
DOUGLASVILLE GA
30135-1543
US

IV. Provider business mailing address

6974 SPRINGWOOD DR
DOUGLASVILLE GA
30135-1543
US

V. Phone/Fax

Practice location:
  • Phone: 770-854-0833
  • Fax:
Mailing address:
  • Phone: 770-854-0833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number StateNULL

VIII. Authorized Official

Name: MONICA LA PAZ
Title or Position: SUPERVISOR
Credential:
Phone: 404-229-4533