Provider Demographics
NPI:1992554422
Name:EVERLASTING LIFE SENIOR CARE
Entity type:Organization
Organization Name:EVERLASTING LIFE SENIOR CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:DELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARKSDALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-262-0319
Mailing Address - Street 1:PO BOX 5124
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30154-0003
Mailing Address - Country:US
Mailing Address - Phone:770-262-0319
Mailing Address - Fax:
Practice Address - Street 1:4519 BRONTE LN
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-4967
Practice Address - Country:US
Practice Address - Phone:770-262-0319
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-16
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty