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General NPI Number Information
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NPI Number | 1215276753
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Entity Type | Organization
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Legal Business Name | HOUSE OF LORD
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Dates
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Enumeration Date | 02/04/2013
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Last Update Date | 02/04/2013
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Provider Practice Location Address
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Address Line | 3802 MACLAND RD
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City | HIRAM
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State | GA
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Zip | 30141-2237
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Country | US
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Telephone | 770-439-4918
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Fax | 770-439-4918
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Provider Business Mailing Address
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Address Line | 3802 MACLAND RD
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City | HIRAM
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State | GA
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Zip | 30141-2237
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Country | US
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Telephone | 770-439-4918
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Fax | 770-439-4918
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. LORIS J CHRISTIE
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Credential | C.N.A
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Telephone | 770-439-4918
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | PCH008009
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License Number State | GA
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