Provider Demographics
NPI:1821514381
Name:LOVING CAMILLA
Entity Type:Organization
Organization Name:LOVING CAMILLA
Other - Org Name:VISITING ANGELS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:TERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-664-0816
Mailing Address - Street 1:106 ADAMSON SQ STE 8
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-3261
Mailing Address - Country:US
Mailing Address - Phone:678-664-0816
Mailing Address - Fax:678-664-0297
Practice Address - Street 1:106 ADAMSON SQ STE 8
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-3261
Practice Address - Country:US
Practice Address - Phone:678-664-0816
Practice Address - Fax:678-664-0297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA022-R-1637251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health