Provider Demographics
NPI:1114343001
Name:LIVE HEALTHY HOMECARE SERVICES
Entity Type:Organization
Organization Name:LIVE HEALTHY HOMECARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR & DIRECTOR OF NURSING
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:BRUCE
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:470-388-4155
Mailing Address - Street 1:1 W COURT SQ
Mailing Address - Street 2:SUITE 750
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-2538
Mailing Address - Country:US
Mailing Address - Phone:407-494-7700
Mailing Address - Fax:470-388-4155
Practice Address - Street 1:1 W COURT SQ
Practice Address - Street 2:SUITE 750
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-2538
Practice Address - Country:US
Practice Address - Phone:404-494-7700
Practice Address - Fax:470-388-4155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-15
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
GARN130295251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA=========Medicaid