Healthcare Provider Details

I. General information

NPI: 1801658646
Provider Name (Legal Business Name): LACOLES HEAL AND TOUCH HOMECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2024
Last Update Date: 01/26/2024
Certification Date: 01/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

933 PINE LOG RD
AIKEN SC
29803-7330
US

IV. Provider business mailing address

2609 SERENITY LN
AUGUSTA GA
30909-0645
US

V. Phone/Fax

Practice location:
  • Phone: 980-505-7748
  • Fax: 706-252-8049
Mailing address:
  • Phone: 980-505-7748
  • Fax: 706-252-8049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385HR2055X
TaxonomyChild Mental Illness Respite Care
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: TAMIKA L MITCHELL
Title or Position: CEO
Credential:
Phone: 980-505-7748