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General NPI Number Information
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NPI Number | 1174131361
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Entity Type | Organization
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Legal Business Name | LILLIE HEALTHCARE, LLC
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Dates
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Enumeration Date | 07/14/2020
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Last Update Date | 07/14/2020
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Provider Practice Location Address
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Address Line | 5002 STREATOR DR
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City | COLUMBUS
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State | GA
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Zip | 31907-8629
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Country | US
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Telephone | 706-330-6782
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Fax |
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Provider Business Mailing Address
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Address Line | 5002 STREATOR DR
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City | COLUMBUS
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State | GA
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Zip | 31907-8629
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Country | US
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Telephone | 706-330-6782
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Fax |
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Authorized Official
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Title or Position | CHIEF STRATEGY OFFICER
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Name | TRENISE HOLLOWAY
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Credential |
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Telephone | 706-330-6782
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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