=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780179804
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEW HOPE HOME CARE SERVICES LLC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/30/2018
-----------------------------------------------------
Last Update Date | 06/30/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4910 JONESBORO RD STE 401
-----------------------------------------------------
City | UNION CITY
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30291-2089
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-882-7483
-----------------------------------------------------
Fax | 770-629-1757
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4910 JONESBORO RD STE 401
-----------------------------------------------------
City | UNION CITY
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30291-2089
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-882-7483
-----------------------------------------------------
Fax | 770-629-1757
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MS. IYUNK A LEWIS
-----------------------------------------------------
Credential | LPN
-----------------------------------------------------
Telephone | 770-882-7483
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | LPN078955
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------