Provider Demographics
NPI:1427366590
Name:SECURE CARE AUGUSTA, LLC
Entity Type:Organization
Organization Name:SECURE CARE AUGUSTA, LLC
Other - Org Name:SECURE CARE AUGUSTA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:LEGRAND
Authorized Official - Last Name:LUNDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-723-9926
Mailing Address - Street 1:1520 MONTE SANO AVE
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-7808
Mailing Address - Country:US
Mailing Address - Phone:706-993-9271
Mailing Address - Fax:
Practice Address - Street 1:1520 MONTE SANO AVE
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-7808
Practice Address - Country:US
Practice Address - Phone:706-993-9271
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-22
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty
No163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, AmbulatoryGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202G706758Medicare PIN