Provider Demographics
NPI:1336766526
Name:LITHONIA HEALTHCARE DEVELOPMENT LLC
Entity type:Organization
Organization Name:LITHONIA HEALTHCARE DEVELOPMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ADRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-484-4610
Mailing Address - Street 1:7414 E GRAND AVE APT 422
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-4249
Mailing Address - Country:US
Mailing Address - Phone:214-603-3975
Mailing Address - Fax:
Practice Address - Street 1:8035 ERL THORNTON FWY
Practice Address - Street 2:456
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75228
Practice Address - Country:US
Practice Address - Phone:214-484-4610
Practice Address - Fax:214-602-4077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-03
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion
No291U00000XLaboratoriesClinical Medical Laboratory
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45D2239956OtherCLIA WAIVER