MEDICARE: COMFORT LIVING365HOME HEALTH CARE LIMITED LIABILITY COMPANY

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

General Provider Information

NPI Number	:	1003659236
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMFORT LIVING365HOME HEALTH CARE LIMITED LIABILITY COMPANY

Provider Business Mailing Address
First Line	:	6770 FLORENCE DR
Second Line	:
City	:	LITHIA SPRINGS
State	:	GA
Zip	:	30122-1929
Country	:	US
Telephone Number	:	404-491-9911
Fax Number	:

Provider Business Practice Location Address
First Line	:	6770 FLORENCE DR
Second Line	:
City	:	LITHIA SPRINGS
State	:	GA
Zip	:	30122-1929
Country	:	US
Telephone Number	:	404-491-9911
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MRS. TASILA SMITH
Credential	:	BSN,RN
Telephone Number	:	678-670-7864

Provider Enumeration Date	:	06/15/2024
Last Update Date	:	06/24/2024

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