Provider Demographics
NPI:1902443393
Name:GINA'S LOVE LLC.
Entity Type:Organization
Organization Name:GINA'S LOVE LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CCO
Authorized Official - Prefix:MRS
Authorized Official - First Name:GINA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:678-505-0299
Mailing Address - Street 1:779 BRASELTON HWY
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-4510
Mailing Address - Country:US
Mailing Address - Phone:816-309-9733
Mailing Address - Fax:678-404-7435
Practice Address - Street 1:779 BRASELTON HWY
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-4510
Practice Address - Country:US
Practice Address - Phone:816-309-9733
Practice Address - Fax:678-404-7435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-04
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN232573OtherGEORGIA BOARD OF NURSING