MEDICARE: IN HIS HONOR 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	:	1992448625
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IN HIS HONOR LLC

Provider Business Mailing Address
First Line	:	3518 OLD REDBUD DR
Second Line	:
City	:	GASTONIA
State	:	NC
Zip	:	28056-9284
Country	:	US
Telephone Number	:	704-864-5500
Fax Number	:	704-864-5565

Provider Business Practice Location Address
First Line	:	4186 OLD YORK RD
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29732-9133
Country	:	US
Telephone Number	:	803-817-1901
Fax Number	:	803-817-1902

Authorized Official
Title or Position	:	OWNER
Name	:	MR. ROY B GOFORTH
Credential	:
Telephone Number	:	704-578-5446

Provider Enumeration Date	:	04/20/2022
Last Update Date	:	04/20/2022

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Directions to “IN HIS HONOR LLC ” Practice Location

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