Healthcare Provider Details

I. General information

NPI: 1407878382
Provider Name (Legal Business Name): PROFESSIONAL CARE HOME HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3126 MILTON RD SUITE 217
CHARLOTTE NC
28215-3778
US

IV. Provider business mailing address

3126 MILTON RD SUITE 217
CHARLOTTE NC
28215-3778
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 Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name: MS. TERESIA M MEDLEY
Title or Position: ADMINISTRATOR
Credential: MSW
Phone: 704-536-7326