Provider Demographics
NPI:1083870547
Name:LOVING CARE ASSISTED LIVING
Entity Type:Organization
Organization Name:LOVING CARE ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSELIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEBRANCHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-225-5687
Mailing Address - Street 1:2666 KACHINA TRL
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-7023
Mailing Address - Country:US
Mailing Address - Phone:678-225-5687
Mailing Address - Fax:
Practice Address - Street 1:854 PORT WEST DR
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:GA
Practice Address - Zip Code:30011-4608
Practice Address - Country:US
Practice Address - Phone:678-225-5687
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-04
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA061013021320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities