Healthcare Provider Details

I. General information

NPI: 1851903371
Provider Name (Legal Business Name): AMERICAN INDIAN MOTHERS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2020
Last Update Date: 11/30/2020
Certification Date: 11/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 S MAIN ST
RED SPRINGS NC
28377-1512
US

IV. Provider business mailing address

120 S MAIN ST
RED SPRINGS NC
28377-1512
US

V. Phone/Fax

Practice location:
  • Phone: 910-543-9911
  • Fax: 910-843-9921
Mailing address:
  • Phone: 910-843-9911
  • Fax: 910-843-9921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: BEVERLY COLLINS-HALL
Title or Position: AGENCY DIRECTOR
Credential:
Phone: 910-843-9911