Healthcare Provider Details

I. General information

NPI: 1548866197
Provider Name (Legal Business Name): ARCHIE HOME CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2020
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 S ELM ST STE 6
GREENSBORO NC
27401-2792
US

IV. Provider business mailing address

1400 RANDOLPH AVE
GREENSBORO NC
27406-2331
US

V. Phone/Fax

Practice location:
  • Phone: 980-208-0776
  • Fax:
Mailing address:
  • Phone: 980-208-0776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MS. TAWANNA ANN ARCHIE
Title or Position: OWNER
Credential:
Phone: 980-208-0776