Healthcare Provider Details

I. General information

NPI: 1144365057
Provider Name (Legal Business Name): OPEN HANDS CAREGIVER SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 INGRAM DR
KING NC
27021-8206
US

IV. Provider business mailing address

PO BOX 1192
TOAST NC
27049-1192
US

V. Phone/Fax

Practice location:
  • Phone: 336-985-0871
  • Fax: 336-985-0871
Mailing address:
  • Phone: 336-789-2944
  • Fax: 336-786-1834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHC3683
License Number StateNC

VII. Legacy identifiers

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

# 1
Identifier6601694
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer

VIII. Authorized Official

Name: MRS. CHARLOTTE WATSON CASSELL
Title or Position: CO-OWNER
Credential: FNP
Phone: 336-789-2944