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General NPI Number Information
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NPI Number | 1073864120
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Entity Type | Organization
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Legal Business Name | BENNETT'S LOVING TOUCH HOME CARE SERVICES LLC
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Dates
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Enumeration Date | 09/28/2012
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Last Update Date | 09/28/2012
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Provider Practice Location Address
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Address Line | 163 SOUTHGATE BLVD
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City | MCDONOUGH
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State | GA
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Zip | 30253-8036
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Country | US
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Telephone | 770-347-7366
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Fax | 229-394-4898
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Provider Business Mailing Address
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Address Line | 163 SOUTHGATE BLVD
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City | MCDONOUGH
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State | GA
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Zip | 30253-8036
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Country | US
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Telephone | 770-347-7366
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Fax | 229-394-4898
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Authorized Official
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Title or Position | OWNER
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Name | MR. DEMETRIC ANTONIO BENNETT
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Credential |
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Telephone | 770-347-7366
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 075-R-1086
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License Number State | GA
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