Healthcare Provider Details

I. General information

NPI: 1083373005
Provider Name (Legal Business Name): TOURMALINE HOME CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2021
Last Update Date: 12/17/2021
Certification Date: 12/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 MUIRS CHAPEL RD STE 336
GREENSBORO NC
27410-6173
US

IV. Provider business mailing address

204 MUIRS CHAPEL RD STE 336
GREENSBORO NC
27410-6173
US

V. Phone/Fax

Practice location:
  • Phone: 336-848-6601
  • Fax:
Mailing address:
  • Phone: 336-848-6601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name: MS. CHANTELL N COOPER
Title or Position: CEO
Credential:
Phone: 336-848-6601