Healthcare Provider Details

I. General information

NPI: 1619498060
Provider Name (Legal Business Name): COMPANION AND HOME CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2017
Last Update Date: 07/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208E BOGUE INLET DR
EMERALD ISLE NC
28594-2703
US

IV. Provider business mailing address

PO BOX 5375
EMERALD ISLE NC
28594-5375
US

V. Phone/Fax

Practice location:
  • Phone: 252-764-9574
  • Fax:
Mailing address:
  • Phone: 252-622-9361
  • 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 Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: MS. AMY LYNN LOCK
Title or Position: OWNER
Credential:
Phone: 252-764-9574