Healthcare Provider Details

I. General information

NPI: 1366712572
Provider Name (Legal Business Name): HEALING HANDS ASSISTED LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2012
Last Update Date: 01/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2667 C ST
MACON GA
31206-8307
US

IV. Provider business mailing address

6601 CARVER AVENUE
TEXASCITY TX
77591
US

V. Phone/Fax

Practice location:
  • Phone: 404-493-0867
  • Fax: 478-254-8837
Mailing address:
  • Phone: 404-493-0867
  • Fax: 478-254-8837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MS. TIMISHEA TILLMAN
Title or Position: OWNER
Credential:
Phone: 404-493-0867