Healthcare Provider Details

I. General information

NPI: 1518635341
Provider Name (Legal Business Name): MODERN HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2021
Last Update Date: 09/07/2021
Certification Date: 09/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10130 PERIMETER PKWY STE 200
CHARLOTTE NC
28216-0197
US

IV. Provider business mailing address

10130 PERIMETER PKWY STE 200
CHARLOTTE NC
28216-0197
US

V. Phone/Fax

Practice location:
  • Phone: 704-608-9898
  • Fax:
Mailing address:
  • Phone: 704-608-9898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: SHEILA RN STEVENSON
Title or Position: CHIEF NURSING OFFICER
Credential: RN, MHA
Phone: 704-608-9898