MEDICARE: ERIC MCKENZIE HOME CARE AGENCY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency	HC4870	NC

General Provider Information

NPI Number	:	1073050621
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ERIC MCKENZIE HOME CARE AGENCY, LLC

Provider Business Mailing Address
First Line	:	8011 N POINT BLVD
Second Line	:	SUITE G
City	:	WINSTON SALEM
State	:	NC
Zip	:	27106-3879
Country	:	US
Telephone Number	:	336-602-6680
Fax Number	:

Provider Business Practice Location Address
First Line	:	8011 N POINT BLVD
Second Line	:	SUITE G
City	:	WINSTON SALEM
State	:	NC
Zip	:	27106-3879
Country	:	US
Telephone Number	:	336-602-6680
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	LAHNIAH M MCINNIS
Credential	:
Telephone Number	:	336-602-6680

Provider Enumeration Date	:	01/20/2017
Last Update Date	:	01/20/2017

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