Healthcare Provider Details

I. General information

NPI: 1962900068
Provider Name (Legal Business Name): MOTIVATED HANDS ASSISTED LOVING CARE LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2018
Last Update Date: 09/16/2021
Certification Date: 09/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5392 TERRYTOWN LN
LITHONIA GA
30038-3900
US

IV. Provider business mailing address

2645 WILLIAMS GRANT REYNOLDS DR APT A
LITHONIA GA
30058-4510
US

V. Phone/Fax

Practice location:
  • Phone: 678-663-3832
  • Fax:
Mailing address:
  • Phone: 678-663-3832
  • 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 Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: COFFY TRIMBLE
Title or Position: CEO
Credential:
Phone: 770-265-7136