Healthcare Provider Details

I. General information

NPI: 1881048858
Provider Name (Legal Business Name): OWENS THERAPEUTIC SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2016
Last Update Date: 10/05/2023
Certification Date: 10/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1661 WALKUP AVE STE E
MONROE NC
28110-3600
US

IV. Provider business mailing address

1661 WALKUP AVE STE E
MONROE NC
28110-3600
US

V. Phone/Fax

Practice location:
  • Phone: 704-289-8229
  • Fax: 704-289-5884
Mailing address:
  • Phone: 704-289-8229
  • Fax: 704-289-5884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberHC4842
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNC

VIII. Authorized Official

Name: MRS. MARIA REGINA CROUCH
Title or Position: CHIEF EXECUTIVE OFFICE
Credential:
Phone: 704-289-8229