Healthcare Provider Details

I. General information

NPI: 1093774614
Provider Name (Legal Business Name): AUTHORACARE COLLECTIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 05/06/2020
Certification Date: 05/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 SUMMIT AVE
GREENSBORO NC
27405-4522
US

IV. Provider business mailing address

2500 SUMMIT AVE
GREENSBORO NC
27405-4522
US

V. Phone/Fax

Practice location:
  • Phone: 336-621-2500
  • Fax: 336-621-4516
Mailing address:
  • Phone: 336-621-2500
  • Fax: 336-621-4516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHC0374
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License NumberHC0374
License Number StateNC

VIII. Authorized Official

Name: MRS. KRISTEN WITHER YNTEMA
Title or Position: CEO
Credential: MBA, MHSA
Phone: 336-621-2500