Healthcare Provider Details

I. General information

NPI: 1407401649
Provider Name (Legal Business Name): LONG LIFE CARE MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2019
Last Update Date: 09/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2111 E LAKE RD STE 100
MCDONOUGH GA
30252-4930
US

IV. Provider business mailing address

2111 E LAKE RD STE 100
MCDONOUGH GA
30252-4930
US

V. Phone/Fax

Practice location:
  • Phone: 770-217-7575
  • Fax: 770-216-1850
Mailing address:
  • Phone: 770-217-7575
  • Fax: 770-216-1850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: TRACY ENGLISH
Title or Position: FOUNDER/CARE MANAGER
Credential: DNP, APRN, FNP-BC
Phone: 770-217-7575