Provider Demographics
NPI:1194172783
Name:FRIENDLY CARE AGENCY LLC
Entity type:Organization
Organization Name:FRIENDLY CARE AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:QUANTEZ
Authorized Official - Middle Name:D
Authorized Official - Last Name:PARKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-216-8250
Mailing Address - Street 1:4480 RIVERSIDE DR STE 20
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-1363
Mailing Address - Country:US
Mailing Address - Phone:478-216-8250
Mailing Address - Fax:
Practice Address - Street 1:4480 RIVERSIDE DR STE 20
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-1363
Practice Address - Country:US
Practice Address - Phone:478-216-8250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-24
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care