Provider Demographics
NPI:1861994295
Name:BELOVED CARE CORPORATION
Entity type:Organization
Organization Name:BELOVED CARE CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JERMAINE
Authorized Official - Middle Name:LADYRELL
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-775-0949
Mailing Address - Street 1:2466 QUENTIN DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-5255
Mailing Address - Country:US
Mailing Address - Phone:404-775-0949
Mailing Address - Fax:770-788-1740
Practice Address - Street 1:1119 CHURCH ST SE STE B
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-2318
Practice Address - Country:US
Practice Address - Phone:770-788-1739
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-01
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA107-R-1176253Z00000X, 385H00000X
374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
No253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty
No385H00000XRespite Care FacilityRespite CareGroup - Single Specialty