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NPI Code Detail

MEDICARE: BELOVED CARE CORPORATION

MEDICARE: BELOVED CARE CORPORATION
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
1253Z00000XIn Home Supportive Care Agency107-R-1176GA
2385H00000XRespite Care107-R-1176GA
3374U00000XHome Health Aide

General Provider Information

NPI Number : 1861994295
Entity Type Code : Organization
Provider Name (Legal Business Name) : BELOVED CARE CORPORATION
Provider Business Mailing Address
First Line : 2466 QUENTIN DR
Second Line :
City : JONESBORO
State : GA
Zip : 30236-5255
Country : US
Telephone Number : 404-775-0949
Fax Number : 770-788-1740
Provider Business Practice Location Address
First Line : 1119 CHURCH ST SE STE B
Second Line :
City : COVINGTON
State : GA
Zip : 30014-2318
Country : US
Telephone Number : 770-788-1739
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : JERMAINE LADYRELL WALKER
Credential :
Telephone Number : 404-775-0949
Provider Enumeration Date : 03/01/2018
Last Update Date : 03/01/2018

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Directions to “BELOVED CARE CORPORATION ” Practice Location

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