Healthcare Provider Details

I. General information

NPI: 1689946782
Provider Name (Legal Business Name): WORTHINGTON CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2012
Last Update Date: 02/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1537 LOVETT ST
GREENSBORO NC
27403-3340
US

IV. Provider business mailing address

1537 LOVETT ST
GREENSBORO NC
27403-3340
US

V. Phone/Fax

Practice location:
  • Phone: 336-965-5922
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MARSHALL WORTHINGTON
Title or Position: SUPERVISOR
Credential:
Phone: 336-965-5922