Organization
LOVING CARE AGENCY, INC.
Active
Other names
AVEANNA HEALTHCARE
Organization subpart
No
Provider details
NPI number
Authorized official
VICKI WHITESIDE (DIRECTOR REGULATORY LICENSING)
(770) 248-8740
Entity
Organization
Contact information
Practice address
111 E LUDWIG RD STE 109, FORT WAYNE, IN 46825-4240
(260) 969-0100
(260) 969-0101
Mailing address
400 INTERSTATE NORTH PKWY SE STE 1600, ATLANTA, GA 30339-5047
(770) 248-8740
(214) 466-1378
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
10-0123950-1
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200884790C
MEDICAID WAIVER PROGRAM
IN
Enumeration date
04/14/2011
Last updated
02/08/2019
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