Healthcare Provider Details

I. General information

NPI: 1881461796
Provider Name (Legal Business Name): HEART & SOUL HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2023
Last Update Date: 12/11/2023
Certification Date: 12/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 S NEW ST
EDEN NC
27288-3616
US

IV. Provider business mailing address

PO BOX 3574
EDEN NC
27289-3574
US

V. Phone/Fax

Practice location:
  • Phone: 336-691-2200
  • Fax:
Mailing address:
  • Phone: 336-253-1584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: TERRANCE ADAMS
Title or Position: PRESIDENT / CEO
Credential:
Phone: 336-253-1584