Healthcare Provider Details

I. General information

NPI: 1528296555
Provider Name (Legal Business Name): HIS HOME CARE AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2009
Last Update Date: 06/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

862 SOUTHWEST DR
DAVIDSON NC
28036-7910
US

IV. Provider business mailing address

2020 BEATTIES FORD RD STE E
CHARLOTTE NC
28216-4573
US

V. Phone/Fax

Practice location:
  • Phone: 980-229-5041
  • Fax: 980-226-5158
Mailing address:
  • Phone: 980-229-8054
  • Fax: 980-226-5158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: GLENDA LEE HANSLEY
Title or Position: AGENCY DIRECTOR
Credential:
Phone: 980-226-5041