MEDICARE: ASSERTIVE HOME CARE SERVICES, INC

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	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1649855073
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASSERTIVE HOME CARE SERVICES, INC

Provider Business Mailing Address
First Line	:	1135 NAN ST
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28314-5908
Country	:	US
Telephone Number	:	910-988-3541
Fax Number	:	910-779-2488

Provider Business Practice Location Address
First Line	:	7619 OVERHILLS RD
Second Line	:
City	:	SPRING LAKE
State	:	NC
Zip	:	28390-8997
Country	:	US
Telephone Number	:	910-988-3541
Fax Number	:	910-779-2488

Authorized Official
Title or Position	:	OWNER/DIRECTOR
Name	:	DONNA HENDERSON
Credential	:
Telephone Number	:	910-988-3541

Provider Enumeration Date	:	03/17/2021
Last Update Date	:	03/17/2021

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