Healthcare Provider Details

I. General information

NPI: 1902134133
Provider Name (Legal Business Name): METROLINA HOME HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2009
Last Update Date: 11/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8410 PIT STOP COURT, SUITE 125
CONCORD NC
28027-8258
US

IV. Provider business mailing address

8410 PIT STOP COURT, SUITE 125
CONCORD NC
28027-8258
US

V. Phone/Fax

Practice location:
  • Phone: 704-707-0575
  • Fax: 704-353-7099
Mailing address:
  • Phone: 704-707-0575
  • Fax: 704-353-7099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHC3933
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberHC3933
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberHC3933
License Number State

VIII. Authorized Official

Name: MRS. TIFFANY CANNON
Title or Position: PRESIDENT
Credential: MA, LPC
Phone: 704-707-0575