Provider Demographics
NPI:1407401649
Name:LONG LIFE CARE MANAGEMENT LLC
Entity Type:Organization
Organization Name:LONG LIFE CARE MANAGEMENT LLC
Other - Org Name:LONG LIFE CARE MANAGEMENT
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:FOUNDER/CARE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:ENGLISH
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APRN, FNP-BC
Authorized Official - Phone:770-217-7575
Mailing Address - Street 1:2111 E LAKE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30252-4930
Mailing Address - Country:US
Mailing Address - Phone:770-217-7575
Mailing Address - Fax:770-216-1850
Practice Address - Street 1:2111 E LAKE RD STE 100
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30252-4930
Practice Address - Country:US
Practice Address - Phone:770-217-7575
Practice Address - Fax:770-216-1850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-05
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251J00000XAgenciesNursing Care