Healthcare Provider Details

I. General information

NPI: 1982856340
Provider Name (Legal Business Name): PROFESSIONAL CARE HOME HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2008
Last Update Date: 10/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3137 AMITY COURT SUITE 400
CHARLOTTE NC
28215
US

IV. Provider business mailing address

3137 AMITY COURT SUITE 400
CHARLOTTE NC
28215
US

V. Phone/Fax

Practice location:
  • Phone: 704-536-7326
  • Fax: 704-536-7147
Mailing address:
  • Phone: 704-536-7326
  • Fax: 704-536-7147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number0000000
License Number StateNC

VIII. Authorized Official

Name: TERESIA MEDLEY
Title or Position: ADMINISTRATOR
Credential:
Phone: 704-536-7326