Provider Demographics
NPI:1255001848
Name:EVERLASTING GROWTH, LLC
Entity Type:Organization
Organization Name:EVERLASTING GROWTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LALOUISE
Authorized Official - Middle Name:
Authorized Official - Last Name:STLOUIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-974-9000
Mailing Address - Street 1:956 BELFRY TER
Mailing Address - Street 2:
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213-5145
Mailing Address - Country:US
Mailing Address - Phone:404-232-9196
Mailing Address - Fax:
Practice Address - Street 1:956 BELFRY TER
Practice Address - Street 2:
Practice Address - City:FAIRBURN
Practice Address - State:GA
Practice Address - Zip Code:30213-5145
Practice Address - Country:US
Practice Address - Phone:678-974-9000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care