Healthcare Provider Details

I. General information

NPI: 1487390704
Provider Name (Legal Business Name): BNZ HEALTHCARE AND TRAINING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2022
Last Update Date: 05/18/2022
Certification Date: 05/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 FRANKLIN GTWY SE STE 202
MARIETTA GA
30067-8900
US

IV. Provider business mailing address

1180 FRANKLIN GTWY SE STE 202
MARIETTA GA
30067-8900
US

V. Phone/Fax

Practice location:
  • Phone: 504-814-1277
  • Fax:
Mailing address:
  • Phone: 504-814-1277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: TRAVICIA LASHANDRA BROWN
Title or Position: OWNER
Credential:
Phone: 504-814-1277