Basic Information
| Provider Information | |||||||||
| NPI: | 1700067774 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LOVING CARE AGENCY, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6 CONCOURSE PKWY STE 1100 | ||||||||
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| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303285359 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7702488740 | ||||||||
| FaxNumber: | 7702488192 | ||||||||
| Practice Location | |||||||||
| Address1: | 1341 ROUTE 9 | ||||||||
| Address2: | UNIT 8 | ||||||||
| City: | TOMS RIVER | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 087554087 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322705788 | ||||||||
| FaxNumber: | 7322702696 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/19/2007 | ||||||||
| LastUpdateDate: | 04/30/2018 | ||||||||
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| AuthorizedOfficialLastName: | WHITESIDE | ||||||||
| AuthorizedOfficialFirstName: | VICKI | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR REGULATORY LICENSING | ||||||||
| AuthorizedOfficialTelephone: | 7702488740 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | HP0076215 | NJ | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 0147699 | 05 | NJ | MEDICAID |