Healthcare Provider Details

I. General information

NPI: 1619124187
Provider Name (Legal Business Name): SENIOR ANGELS DAY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2008
Last Update Date: 08/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 PEAR TREE CT
GREENSBORO NC
27401-4075
US

IV. Provider business mailing address

6 PEAR TREE CT
GREENSBORO NC
27401-4075
US

V. Phone/Fax

Practice location:
  • Phone: 336-601-8143
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: MS. M. RUTH DEVANE
Title or Position: CEO
Credential:
Phone: 336-601-8143