Healthcare Provider Details

I. General information

NPI: 1144619495
Provider Name (Legal Business Name): ASSURED LOVING CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2015
Last Update Date: 01/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 CECIL ST
THOMASVILLE GA
31792-5605
US

IV. Provider business mailing address

108 CECIL ST
THOMASVILLE GA
31792-5605
US

V. Phone/Fax

Practice location:
  • Phone: 229-236-0159
  • Fax:
Mailing address:
  • Phone: 229-236-0159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: ANGELA COPELAND
Title or Position: AGENCY DIRECTOR & FOUNDER
Credential:
Phone: 619-381-7406