Healthcare Provider Details

I. General information

NPI: 1578972329
Provider Name (Legal Business Name): TOUCH A LIFE HEALTH CARE (LLC)
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2014
Last Update Date: 08/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 TROY EDWARDS RD.
EATONTON GA
31024
US

IV. Provider business mailing address

105 TROY EDWARDS RD.
EATONTON GA
31024
US

V. Phone/Fax

Practice location:
  • Phone: 706-473-3662
  • Fax:
Mailing address:
  • Phone: 706-473-3662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name: MISS ANDREA MICHELLE MONDAY
Title or Position: COUNSELOR
Credential:
Phone: 706-473-3662