Healthcare Provider Details

I. General information

NPI: 1619247343
Provider Name (Legal Business Name): BELOVED CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2012
Last Update Date: 01/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 LONDON WAY
LITHIA SPRINGS GA
30122-6804
US

IV. Provider business mailing address

314 LONDON WAY
LITHIA SPRINGS GA
30122-6804
US

V. Phone/Fax

Practice location:
  • Phone: 770-510-6830
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MARIA W FUTCH
Title or Position: CEO
Credential:
Phone: 770-510-6830