Healthcare Provider Details

I. General information

NPI: 1104196807
Provider Name (Legal Business Name): GATE CITY OF BURLINGTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2012
Last Update Date: 01/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2603 HOLLY HILL STREET
BURLINGTON NC
27215
US

IV. Provider business mailing address

2603 HOLLY HILL ST
BURLINGTON NC
27215-5156
US

V. Phone/Fax

Practice location:
  • Phone: 336-270-7061
  • Fax:
Mailing address:
  • Phone: 336-270-7061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberHC4039
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License NumberHC4039
License Number StateNC

VIII. Authorized Official

Name: JACKIE CHAMBERS
Title or Position: OWNER
Credential:
Phone: 336-270-7061