Healthcare Provider Details

I. General information

NPI: 1609481506
Provider Name (Legal Business Name): LOVING HANDS FOUNDATION INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2020
Last Update Date: 10/29/2020
Certification Date: 10/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 UNION ST
LAGRANGE GA
30241-3343
US

IV. Provider business mailing address

1087 HAMMETT RD
LAGRANGE GA
30241-9378
US

V. Phone/Fax

Practice location:
  • Phone: 706-333-7222
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CARLA LESLIE-GOODEN
Title or Position: EXECUTIVE ASSISTANT
Credential:
Phone: 404-343-5996