Provider Demographics
NPI:1992053532
Name:BURTON HOME CARE LLC
Entity type:Organization
Organization Name:BURTON HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:VERLENE
Authorized Official - Middle Name:B
Authorized Official - Last Name:WISE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-340-2899
Mailing Address - Street 1:21 IVYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HULL
Mailing Address - State:GA
Mailing Address - Zip Code:30646-4034
Mailing Address - Country:US
Mailing Address - Phone:706-340-2899
Mailing Address - Fax:706-549-3975
Practice Address - Street 1:21 IVYWOOD DR
Practice Address - Street 2:
Practice Address - City:HULL
Practice Address - State:GA
Practice Address - Zip Code:30646-4034
Practice Address - Country:US
Practice Address - Phone:706-340-2899
Practice Address - Fax:706-549-3975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-28
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA095R0821253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care