=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700067774
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LOVING CARE AGENCY, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/19/2007
-----------------------------------------------------
Last Update Date | 04/30/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1341 ROUTE 9 UNIT 8
-----------------------------------------------------
City | TOMS RIVER
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08755-4087
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-270-5788
-----------------------------------------------------
Fax | 732-270-2696
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6 CONCOURSE PKWY STE 1100
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30328-5359
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-248-8740
-----------------------------------------------------
Fax | 770-248-8192
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR REGULATORY LICENSING
-----------------------------------------------------
Name | VICKI WHITESIDE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 770-248-8740
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | HP0076215
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------