Healthcare Provider Details

I. General information

NPI: 1649666876
Provider Name (Legal Business Name): WORTHINGTON HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2015
Last Update Date: 04/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 W TERRELL ST
GREENSBORO NC
27406-2750
US

IV. Provider business mailing address

4104 SACRAMENTO DR
GREENSBORO NC
27406-6323
US

V. Phone/Fax

Practice location:
  • Phone: 336-965-0153
  • Fax:
Mailing address:
  • Phone: 336-965-0153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number263875
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number263875
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number263875
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number263875
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number263875
License Number StateNC
# 6
Primary TaxonomyN
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number263875
License Number StateNC
# 7
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number263875
License Number StateNC

VIII. Authorized Official

Name: MARSHALL WORTHINGTON
Title or Position: REPRESENTATIVE
Credential:
Phone: 336-965-0153