Healthcare Provider Details

I. General information

NPI: 1649896036
Provider Name (Legal Business Name): TINA ROCHELL MEBANE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2020
Last Update Date: 11/18/2021
Certification Date: 11/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1031 SUMMIT AVE STE S-4
GREENSBORO NC
27405-7010
US

IV. Provider business mailing address

PO BOX 5016
GREENSBORO NC
27435-0016
US

V. Phone/Fax

Practice location:
  • Phone: 336-456-2370
  • Fax: 336-763-5065
Mailing address:
  • Phone: 336-456-2370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: