MEDICARE: LIVING LIFE HOME CARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	060-R-1456	GA

General Provider Information

NPI Number	:	1003292798
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIVING LIFE HOME CARE

Provider Business Mailing Address
First Line	:	1958 TIGER FLOWERS DR NW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30314-1347
Country	:	US
Telephone Number	:	404-552-3666
Fax Number	:

Provider Business Practice Location Address
First Line	:	5532 OLD NATIONAL HWY
Second Line	:	SUITE 100 BLDG G
City	:	ATLANTA
State	:	GA
Zip	:	30349-3277
Country	:	US
Telephone Number	:	470-355-9411
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. BOBBY LERAY SCOTT
Credential	:	MA/CNA
Telephone Number	:	470-355-9411

Provider Enumeration Date	:	08/04/2015
Last Update Date	:	08/04/2015

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Directions to “LIVING LIFE HOME CARE ” Practice Location

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