Healthcare Provider Details

I. General information

NPI: 1053200055
Provider Name (Legal Business Name): CAREWAVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2025
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1677 SWEET BLOSSOM TRL
LAWRENCEVILLE GA
30043-6557
US

IV. Provider business mailing address

2100 RIVERSIDE PKWY SUITE 128 # 1090
LAWRENCEVILLE GA
30043-5936
US

V. Phone/Fax

Practice location:
  • Phone: 305-773-6215
  • Fax:
Mailing address:
  • Phone: 305-773-6215
  • 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 Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: CYNTHIA QUINONES
Title or Position: ADMINISTRATOR
Credential:
Phone: 305-773-6215