Healthcare Provider Details

I. General information

NPI: 1417473430
Provider Name (Legal Business Name): AT YOUR PLACE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1837 SARDONYX RD UNIT 4
FAYETTEVILLE NC
28303-5808
US

IV. Provider business mailing address

111 LAMON STREET SUITE 118
FAYETTEVILLE NC
28301
US

V. Phone/Fax

Practice location:
  • Phone: 910-229-2711
  • Fax: 910-229-2495
Mailing address:
  • Phone: 910-229-2711
  • Fax: 910-229-2495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number630418120004
License Number StateNC

VIII. Authorized Official

Name: TERA TOWNSEND
Title or Position: OWNER / MEMBER
Credential:
Phone: 910-229-2711