Healthcare Provider Details

I. General information

NPI: 1215213244
Provider Name (Legal Business Name): MARY LEANORA HENRY MAEDU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2011
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4614 WILGROVE MINT HILL RD STE H
MINT HILL NC
28227-3547
US

IV. Provider business mailing address

4614 WILGROVE MINT HILL RD STE H
MINT HILL NC
28227-3547
US

V. Phone/Fax

Practice location:
  • Phone: 864-978-6439
  • Fax:
Mailing address:
  • Phone: 864-978-6439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberHC7888
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: