Healthcare Provider Details

I. General information

NPI: 1003106774
Provider Name (Legal Business Name): LOVING CARE AGENCY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2011
Last Update Date: 02/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E LUDWIG RD STE 109
FORT WAYNE IN
46825-4240
US

IV. Provider business mailing address

400 INTERSTATE NORTH PKWY SE STE 1600
ATLANTA GA
30339-5047
US

V. Phone/Fax

Practice location:
  • Phone: 260-969-0100
  • Fax: 260-969-0101
Mailing address:
  • Phone: 770-248-8740
  • Fax: 214-466-1378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number10-0123950-1
License Number StateIN

VIII. Authorized Official

Name: VICKI WHITESIDE
Title or Position: DIRECTOR REGULATORY LICENSING
Credential:
Phone: 770-248-8740