MEDICARE: LIVING AT EASE INCORPORATED

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	:	1609412782
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIVING AT EASE INCORPORATED

Provider Business Mailing Address
First Line	:	7828 MONOGRAMM LN
Second Line	:
City	:	MINT HILL
State	:	NC
Zip	:	28227-6534
Country	:	US
Telephone Number	:	704-615-1125
Fax Number	:	888-867-8574

Provider Business Practice Location Address
First Line	:	8501 TOWER POINT DR STE B15
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28227-7849
Country	:	US
Telephone Number	:	704-615-1125
Fax Number	:	888-867-8574

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MIRIAM GRIMES-REID
Credential	:	RN
Telephone Number	:	704-615-1125

Provider Enumeration Date	:	11/23/2019
Last Update Date	:	12/07/2019

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