Provider Demographics
NPI:1003292798
Name:LIVING LIFE HOME CARE
Entity Type:Organization
Organization Name:LIVING LIFE HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:LERAY
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MA/CNA
Authorized Official - Phone:470-355-9411
Mailing Address - Street 1:1958 TIGER FLOWERS DR NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30314-1347
Mailing Address - Country:US
Mailing Address - Phone:404-552-3666
Mailing Address - Fax:
Practice Address - Street 1:5532 OLD NATIONAL HWY
Practice Address - Street 2:SUITE 100 BLDG G
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30349-3277
Practice Address - Country:US
Practice Address - Phone:470-355-9411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-04
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA060-R-1456251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health