Healthcare Provider Details

I. General information

NPI: 1083699607
Provider Name (Legal Business Name): DUDLEY'S HOME HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 07/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 WILLIAMSON RD SUITE 102
MOORESVILLE NC
28117-6899
US

IV. Provider business mailing address

223 WILLIAMSON RD SUITE 102
MOORESVILLE NC
28117-6899
US

V. Phone/Fax

Practice location:
  • Phone: 704-799-3363
  • Fax: 704-799-3635
Mailing address:
  • Phone: 704-799-3363
  • Fax: 704-799-3635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License NumberHC2330
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHC2330
License Number StateNC

VIII. Authorized Official

Name: MRS. LONDA CARR DUDLEY
Title or Position: CEO
Credential:
Phone: 704-799-3363