Healthcare Provider Details

I. General information

NPI: 1780484824
Provider Name (Legal Business Name): FAMILY OF LIFE HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2025
Last Update Date: 02/18/2026
Certification Date: 02/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1822 BETHLEA AVE
MACON GA
31204-5814
US

IV. Provider business mailing address

1822 BETHLEA AVE
MACON GA
31204-5814
US

V. Phone/Fax

Practice location:
  • Phone: 478-284-2547
  • Fax:
Mailing address:
  • Phone: 478-284-2547
  • 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 Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: NERESSA MILLER
Title or Position: PATIENT SAFETY ATTENDANTS
Credential: CNA
Phone: 478-284-2547