Healthcare Provider Details

I. General information

NPI: 1235777988
Provider Name (Legal Business Name): A GREAT CHOICE FOR HOME CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2019
Last Update Date: 01/30/2020
Certification Date: 01/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1671 WELLONS DR
FAYETTEVILLE NC
28304-5054
US

IV. Provider business mailing address

626 MABEL ST
YOUNGSTOWN OH
44502-2226
US

V. Phone/Fax

Practice location:
  • Phone: 919-396-1222
  • Fax: 910-339-0237
Mailing address:
  • Phone: 919-396-1222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: DINEZ BAKER
Title or Position: PRESIDENT
Credential:
Phone: 919-396-1222