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NPI Code Detail

MEDICARE: PENINSULA HOME CARE AT NANTICOKE LLC

MEDICARE: PENINSULA HOME CARE AT NANTICOKE 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
1251E00000XHome Health Agency087036DE

General Provider Information

NPI Number : 1780664953
Entity Type Code : Organization
Provider Name (Legal Business Name) : PENINSULA HOME CARE AT NANTICOKE LLC
Provider Business Mailing Address
First Line : 2459 WILKINSON BLVD STE 120
Second Line :
City : CHARLOTTE
State : NC
Zip : 28208-5669
Country : US
Telephone Number : 704-831-5059
Fax Number :
Provider Business Practice Location Address
First Line : 10252 STONE CREEK DR UNIT 3
Second Line :
City : LAUREL
State : DE
Zip : 19956-4706
Country : US
Telephone Number : 302-691-9898
Fax Number :
Authorized Official
Title or Position : VICE PRESIDENT
Name : MR. TODD WIEBUSCH
Credential :
Telephone Number : 704-731-2403
Provider Enumeration Date : 01/21/2006
Last Update Date : 05/05/2025

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Directions to “PENINSULA HOME CARE AT NANTICOKE LLC ” Practice Location

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