Provider Demographics
NPI:1730618265
Name:BALANCED LIFE HEALTH CARE SOLUTIONS LLC
Entity type:Organization
Organization Name:BALANCED LIFE HEALTH CARE SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP/PROVIDER MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:TONITA
Authorized Official - Middle Name:
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, FNP-BC
Authorized Official - Phone:770-331-6475
Mailing Address - Street 1:1846 OLD NORCROSS RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-8801
Mailing Address - Country:US
Mailing Address - Phone:678-729-7453
Mailing Address - Fax:
Practice Address - Street 1:1846 OLD NORCROSS RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-8801
Practice Address - Country:US
Practice Address - Phone:678-729-7453
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty