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General NPI Number Information
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NPI Number | 1689299356
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Entity Type | Organization
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Legal Business Name | LOVING HANDS OF GRACE, LLC
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Dates
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Enumeration Date | 06/09/2020
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Last Update Date | 06/09/2020
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Provider Practice Location Address
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Address Line | 3876 NORTHSIDE DR APT 804
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City | MACON
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State | GA
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Zip | 31210-2447
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Country | US
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Telephone | 478-719-6646
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Fax |
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Provider Business Mailing Address
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Address Line | 3876 NORTHSIDE DR APT 804
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City | MACON
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State | GA
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Zip | 31210-2447
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Country | US
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Telephone | 478-719-6646
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MISS ERICA NICOLE WATFORD
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Credential | CMAA
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Telephone | 478-719-6646
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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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