MEDICARE: LOYALTY RESIDENCE CARE 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	:	1770348146
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOYALTY RESIDENCE CARE LLC

Provider Business Mailing Address
First Line	:	4804 PAGE CREEK LN STE 216
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27703-8582
Country	:	US
Telephone Number	:	919-809-9797
Fax Number	:

Provider Business Practice Location Address
First Line	:	4804 PAGE CREEK LN STE 216
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27703-8582
Country	:	US
Telephone Number	:	919-809-9797
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. SHANIKA PERKINS
Credential	:
Telephone Number	:	919-809-9797

Provider Enumeration Date	:	02/15/2024
Last Update Date	:	02/15/2024

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