1861994295 NPI number — BELOVED CARE CORPORATION

Table of content: (NPI 1861994295)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861994295 NPI number — BELOVED CARE CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BELOVED CARE CORPORATION
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:
VISITING ANGELS
Provider Other Organization Name Type Code:
3
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:
1861994295
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/01/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2466 QUENTIN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JONESBORO
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30236-5255
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-775-0949
Provider Business Mailing Address Fax Number:
770-788-1740

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1119 CHURCH ST SE STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COVINGTON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30014-2318
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-788-1739
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/01/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WALKER
Authorized Official First Name:
JERMAINE
Authorized Official Middle Name:
LADYRELL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
404-775-0949

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X , with the licence number:  107-R-1176 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 374U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 385H00000X , with the licence number: 107-R-1176 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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