Healthcare Provider Details

I. General information

NPI: 1962637801
Provider Name (Legal Business Name): TSH-PDN SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2009
Last Update Date: 05/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

756 TYVOLA RD SUITE 143
CHARLOTTE NC
28217-3588
US

IV. Provider business mailing address

PO BOX 242036
CHARLOTTE NC
28224-2036
US

V. Phone/Fax

Practice location:
  • Phone: 704-493-3422
  • Fax: 704-525-2506
Mailing address:
  • Phone: 704-493-3422
  • Fax: 704-525-2506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: VERONICA SOUTHERLAND
Title or Position: ADMINISTRATOR
Credential: RN, BSW
Phone: 704-493-3422