Provider Demographics
NPI:1962047597
Name:LD HEALTHCARE SERVICE, LLC
Entity type:Organization
Organization Name:LD HEALTHCARE SERVICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:770-648-2267
Mailing Address - Street 1:1976 ALCOVY TRACE WAY
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-7937
Mailing Address - Country:US
Mailing Address - Phone:770-648-2267
Mailing Address - Fax:229-389-2638
Practice Address - Street 1:1976 ALCOVY TRACE WAY
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-7937
Practice Address - Country:US
Practice Address - Phone:770-648-2267
Practice Address - Fax:229-389-2638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-07
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003223819AMedicaid
GA003223819BMedicaid