Healthcare Provider Details

I. General information

NPI: 1932959285
Provider Name (Legal Business Name): LILLIE'S ADULT DAY CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2024
Last Update Date: 03/26/2024
Certification Date: 03/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3755 BLOOMFIELD RD STE 12B
MACON GA
31206-3655
US

IV. Provider business mailing address

5120 NISBET DR
MACON GA
31206-4724
US

V. Phone/Fax

Practice location:
  • Phone: 478-216-6336
  • Fax:
Mailing address:
  • Phone: 478-508-9247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ERIKA J THOMAS
Title or Position: OWNER
Credential:
Phone: 478-508-9247