Provider Demographics
NPI:1104193044
Name:HEALING HANDS ASSISTED LIVING LLC
Entity Type:Organization
Organization Name:HEALING HANDS ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMISHEA
Authorized Official - Middle Name:
Authorized Official - Last Name:TILLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-493-0867
Mailing Address - Street 1:2667 C ST
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31206-8307
Mailing Address - Country:US
Mailing Address - Phone:404-493-0867
Mailing Address - Fax:478-741-0449
Practice Address - Street 1:4706 BUESCHER CT
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-1284
Practice Address - Country:US
Practice Address - Phone:404-493-0867
Practice Address - Fax:478-741-0449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-21
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness