1689700627 NPI number — LOVING CARE AGENCY, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689700627 NPI number — LOVING CARE AGENCY, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOVING CARE AGENCY, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689700627
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/27/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 INTERSTATE NORTH PKWY SE STE 1600
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30339-5047
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
470-464-8000
Provider Business Mailing Address Fax Number:
770-248-8192

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3 AAA DR
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
HAMILTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08691-1814
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-414-0720
Provider Business Practice Location Address Fax Number:
856-414-0722
Provider Enumeration Date:
02/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BUCKHALTER
Authorized Official First Name:
MATTHEW
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
470-464-8000

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  HP0076200 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8712603 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com