Healthcare Provider Details

I. General information

NPI: 1154075596
Provider Name (Legal Business Name): BALANCED CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2022
Last Update Date: 02/04/2022
Certification Date: 02/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4652 STONE LN
STONE MOUNTAIN GA
30083-2551
US

IV. Provider business mailing address

4652 STONE LN
STONE MOUNTAIN GA
30083-2551
US

V. Phone/Fax

Practice location:
  • Phone: 404-508-8957
  • Fax:
Mailing address:
  • Phone: 843-754-1842
  • 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

VIII. Authorized Official

Name: MS. VANESSA LAWRENCE
Title or Position: ADMINISTRATOR
Credential: MPH
Phone: 843-754-1842