Healthcare Provider Details

I. General information

NPI: 1427350313
Provider Name (Legal Business Name): WHITE SWAN HOME HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2010
Last Update Date: 11/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 EASTCHESTER DR D
HIGH POINT NC
27262-7673
US

IV. Provider business mailing address

PO BOX 260714
PEMBROKE PINES FL
33026-7714
US

V. Phone/Fax

Practice location:
  • Phone: 954-479-9856
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHC4238
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. JOHNATHAUN LEE
Title or Position: BUSINESS MANAGER
Credential:
Phone: 954-479-9856