# PREVENTIVE & FITNESS HEALTHCARE AGENCY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1578276887
- **Authorized official:** MRS. WYLENE WORTHEN REGISTERED NURSE (ADMINISTRATOR/OWNER)
- **Authorized official phone:** (478) 456-9438

## Contact information

- **Practice address:** 1800 N RIDGE DR STE 1, MILLEDGEVILLE, GA 31061-2258
- **Practice address phone:** (478) 295-2955
- **Practice address fax:** (475) 295-3210
- **Mailing address:** 1800 N RIDGE DR STE 1, MILLEDGEVILLE, GA 31061-2258
- **Mailing address phone:** (478) 295-2955
- **Mailing address fax:** (475) 295-3210

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 253Z00000X | In Home Supportive Care Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 01/02/2023
- **Last updated:** 01/02/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 003232271A | — | GA |