Provider Demographics
NPI:1962900068
Name:MOTIVATED HANDS ASSISTED LOVING CARE LLC.
Entity type:Organization
Organization Name:MOTIVATED HANDS ASSISTED LOVING CARE LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:COFFY
Authorized Official - Middle Name:
Authorized Official - Last Name:TRIMBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-265-7136
Mailing Address - Street 1:2645 WILLIAMS GRANT REYNOLDS DR APT A
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-4510
Mailing Address - Country:US
Mailing Address - Phone:678-663-3832
Mailing Address - Fax:
Practice Address - Street 1:5392 TERRYTOWN LN
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30038-3900
Practice Address - Country:US
Practice Address - Phone:678-663-3832
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-24
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA20245153OtherCONTROL NUMBER