Healthcare Provider Details

I. General information

NPI: 1548576408
Provider Name (Legal Business Name): SISTERS OF HEALING HANDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2010
Last Update Date: 08/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 BRIDGE WAY
LAWRENCEVILLE GA
30046-7367
US

IV. Provider business mailing address

508 BRIDGE WAY
LAWRENCEVILLE GA
30046-7367
US

V. Phone/Fax

Practice location:
  • Phone: 770-334-1121
  • Fax:
Mailing address:
  • Phone: 770-334-1121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number067-R-0780
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number067-R-0780
License Number StateGA

VIII. Authorized Official

Name: MS. JORITA PERRI ALEXANDER
Title or Position: ASSISTANT DIRECTOR
Credential: LPN
Phone: 770-334-1121