Healthcare Provider Details

I. General information

NPI: 1033992409
Provider Name (Legal Business Name): BACK TO THE BASICS NURSING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2023
Last Update Date: 08/17/2023
Certification Date: 08/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

179 GOODALL WOODS DR
MACON GA
31216-6498
US

IV. Provider business mailing address

179 GOODALL WOODS DR
MACON GA
31216-6498
US

V. Phone/Fax

Practice location:
  • Phone: 478-796-3858
  • Fax:
Mailing address:
  • Phone: 478-796-3858
  • 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 Code282E00000X
TaxonomyLong Term Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: MISS LAMONICA CARSON
Title or Position: LPN
Credential: LPN
Phone: 478-796-3858