MEDICARE: SALUBRIOUS LLC

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	253Z00000X	In Home Supportive Care Agency
2	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1336896109
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SALUBRIOUS LLC

Provider Business Mailing Address
First Line	:	2357 WARM SPRINGS RD STE 135
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-5668
Country	:	US
Telephone Number	:	225-284-6677
Fax Number	:

Provider Business Practice Location Address
First Line	:	2357 WARM SPRINGS RD STE 135
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-5668
Country	:	US
Telephone Number	:	225-284-6677
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT/NURSE SUPERVISOR
Name	:	NATALIE LYKES
Credential	:
Telephone Number	:	225-284-6677

Provider Enumeration Date	:	03/02/2022
Last Update Date	:	03/04/2022

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