Healthcare Provider Details

I. General information

NPI: 1427292309
Provider Name (Legal Business Name): HAZEL'S HOME CARE SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2009
Last Update Date: 04/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 CRUTCHFIELD RD
REIDSVILLE NC
27320-8265
US

IV. Provider business mailing address

707 PIEDMONT ST
REIDSVILLE NC
27320-3623
US

V. Phone/Fax

Practice location:
  • Phone: 336-349-4887
  • Fax: 336-342-1918
Mailing address:
  • Phone: 336-349-4887
  • Fax: 336-342-1918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberFCL 079 074
License Number StateNC

VIII. Authorized Official

Name: HAZEL E CANNON
Title or Position: ADMIMISTRATOR
Credential:
Phone: 336-342-3031