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General NPI Number Information
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NPI Number | 1538544697
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Entity Type | Organization
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Legal Business Name | LUCY'S PERSONAL CARE LLC
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Dates
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Enumeration Date | 07/29/2015
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Last Update Date | 07/29/2015
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Provider Practice Location Address
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Address Line | 2002 CLEVELAND RD
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City | BOGART
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State | GA
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Zip | 30622-1644
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Country | US
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Telephone | 770-725-7762
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Fax | 770-725-2192
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Provider Business Mailing Address
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Address Line | 217 FOWLER MILL RD
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City | BOGART
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State | GA
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Zip | 30622-1613
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Country | US
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Telephone | 770-725-7943
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Fax | 770-725-2192
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Authorized Official
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Title or Position | OWNER
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Name | MRS. VERA GILES
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Credential |
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Telephone | 770-725-7943
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | PCH008602
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License Number State | GA
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