Healthcare Provider Details

I. General information

NPI: 1104145051
Provider Name (Legal Business Name): PROSPECT HOME CARE SERVICES,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2010
Last Update Date: 02/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

685 NORTH CANNON BLVD
KANNAPOLIS NC
28083-3778
US

IV. Provider business mailing address

685 NORTH CANNON BLVD
KANNAPOLIS NC
28083-3778
US

V. Phone/Fax

Practice location:
  • Phone: 704-934-2330
  • Fax: 704-934-2335
Mailing address:
  • Phone: 704-934-2330
  • Fax: 704-934-2335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHC3981
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberHC3981
License Number StateNC

VIII. Authorized Official

Name: HELEN I BEDU
Title or Position: AGENCY DIRECTOR
Credential: RN
Phone: 704-934-2330