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General NPI Number Information
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NPI Number | 1013290436
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Entity Type | Organization
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Legal Business Name | LIVING PRIVATE HOME CARE
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Dates
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Enumeration Date | 09/21/2011
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Last Update Date | 09/21/2011
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Provider Practice Location Address
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Address Line | 3034 GRAND AVE SW N/A
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City | ATLANTA
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State | GA
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Zip | 30315-9020
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Country | US
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Telephone | 404-518-0619
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Fax | 770-964-0694
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Provider Business Mailing Address
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Address Line | 3034 GRAND AVE SW N/A
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City | ATLANTA
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State | GA
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Zip | 30315-9020
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Country | US
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Telephone | 404-518-0619
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Fax | 770-969-0694
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | MS. NNENNA M. EKEKE
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Credential | N/A
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Telephone | 404-518-0619
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number | 0060R0065
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License Number State | GA
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