Provider Demographics
NPI:1013172402
Name:CROWNCARE
Entity Type:Organization
Organization Name:CROWNCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:LASHANDA
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-933-7899
Mailing Address - Street 1:2480 WINDY HILL RD SE STE 107
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-8608
Mailing Address - Country:US
Mailing Address - Phone:770-933-1899
Mailing Address - Fax:609-935-1899
Practice Address - Street 1:2480 WINDY HILL RD SE STE 107
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8608
Practice Address - Country:US
Practice Address - Phone:770-933-1899
Practice Address - Fax:609-935-1899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-24
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033-R-0473251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health