Healthcare Provider Details

I. General information

NPI: 1578157624
Provider Name (Legal Business Name): PROFESSIONAL TOUCH HOME CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2021
Last Update Date: 03/01/2021
Certification Date: 03/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3205 STONYPOINTE DR
GREENSBORO NC
27406-5421
US

IV. Provider business mailing address

3205 STONYPOINTE DR
GREENSBORO NC
27406-5421
US

V. Phone/Fax

Practice location:
  • Phone: 336-470-1712
  • Fax:
Mailing address:
  • Phone: 336-470-1712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: STEPHON DIONTE WILKERSON
Title or Position: DIRECTOR
Credential:
Phone: 336-470-1712