Healthcare Provider Details

I. General information

NPI: 1497048417
Provider Name (Legal Business Name): TABONO CAP SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2011
Last Update Date: 06/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16930 W CATAWBA AVE SUITE 100-C
CORNELIUS NC
28031-5638
US

IV. Provider business mailing address

PO BOX 480428
CHARLOTTE NC
28269-5320
US

V. Phone/Fax

Practice location:
  • Phone: 704-892-1300
  • Fax: 704-892-1505
Mailing address:
  • Phone: 704-892-1300
  • Fax: 704-892-1505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHC4110
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License NumberHC4110
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License NumberHC4110
License Number StateNC

VIII. Authorized Official

Name: MS. TAMARA D LEWIS
Title or Position: OWNER
Credential:
Phone: 704-892-1300