Healthcare Provider Details

I. General information

NPI: 1649189879
Provider Name (Legal Business Name): SOUTHTRUST HOMECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 RELICT DR LOT 146
CLAYTON NC
27527-6710
US

IV. Provider business mailing address

57 RELICT DR LOT 146
CLAYTON NC
27527-6710
US

V. Phone/Fax

Practice location:
  • Phone: 919-746-1604
  • Fax: --
Mailing address:
  • Phone: 919-746-1604
  • Fax: --

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State

VIII. Authorized Official

Name: CHUKWUDI C OKOH
Title or Position: CEO
Credential: CNA
Phone: 919-746-1604