Healthcare Provider Details

I. General information

NPI: 1134556186
Provider Name (Legal Business Name): ASSURANCE HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2013
Last Update Date: 11/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6512 SIX FORKS RD SUITE 502B
RALEIGH NC
27615-6561
US

IV. Provider business mailing address

3421 FUTURA LN
RALEIGH NC
27610-6057
US

V. Phone/Fax

Practice location:
  • Phone: 919-520-8118
  • Fax: 919-662-2741
Mailing address:
  • Phone: 347-204-4672
  • Fax: 919-662-2741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number150876
License Number StateNC

VIII. Authorized Official

Name: MR. CALVIN K COATES
Title or Position: ASSISTANT DIRECTOR
Credential:
Phone: 347-204-4672