MEDICARE: LOR-RAINE 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

General Provider Information

NPI Number	:	1568086858
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOR-RAINE HOME CARE AGENCY LLC

Provider Business Mailing Address
First Line	:	2413 ROBESON ST STE 1
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28305-5500
Country	:	US
Telephone Number	:	910-491-3069
Fax Number	:

Provider Business Practice Location Address
First Line	:	2413 ROBESON ST STE 1
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28305-5500
Country	:	US
Telephone Number	:	910-491-3069
Fax Number	:	910-229-2141

Authorized Official
Title or Position	:	AGENCY DIRECTOR
Name	:	MRS. TIJUANA DEL ROYA WHITE
Credential	:
Telephone Number	:	910-528-7921

Provider Enumeration Date	:	06/02/2020
Last Update Date	:	06/03/2020

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