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General NPI Number Information
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NPI Number | 1861778748
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Entity Type | Organization
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Legal Business Name | HEAVENLY HANDS OF AUGUSTA, LLC
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Dates
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Enumeration Date | 10/24/2011
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Last Update Date | 10/24/2011
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Provider Practice Location Address
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Address Line | 3365 TANGLEWOOD DRIVE
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City | AUGUSTA
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State | GA
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Zip | 30909-3365
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Country | US
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Telephone | 706-306-0074
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Fax |
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Provider Business Mailing Address
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Address Line | 3365 TANGLEWOOD DRIVE
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City | AUGUSTA
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State | GA
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Zip | 30909
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. FELICIA J BURNS
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Credential |
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Telephone | 706-306-0074
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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 | PCH007134
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | LCB2011001155
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License Number State | GA
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