Provider Demographics
NPI:1144814617
Name:LAKE LANIER SENIOR CARE LLC
Entity type:Organization
Organization Name:LAKE LANIER SENIOR CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:RIGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-534-5880
Mailing Address - Street 1:115 1/2 BRADFORD ST SE STE 210
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-3703
Mailing Address - Country:US
Mailing Address - Phone:770-534-5880
Mailing Address - Fax:770-534-5839
Practice Address - Street 1:115 1/2 BRADFORD ST SE STE 210
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3703
Practice Address - Country:US
Practice Address - Phone:770-534-5880
Practice Address - Fax:770-534-5839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-25
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care