Organization
LUCIENNE HOME CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LUCIENNE B JOHNSON (OWNER)
(167) 878-9073
Entity
Organization
Contact information
Practice address
2407 HI ROC RD NE, CONYERS, GA 30012-2541
(177) 028-5667
Mailing address
2407 HI ROC RD NE, CONYERS, GA 30012-2541
(177) 028-5667
Taxonomy
Speciality
Code
Description
License number
State
251J00000X
Nursing Care Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PHCP010882
—
GA
Enumeration date
10/16/2020
Last updated
10/16/2020
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