Healthcare Provider Details

I. General information

NPI: 1679540512
Provider Name (Legal Business Name): MECKLENBURG HOME HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 JAKE ALEXANDER BLVD W SUITE 102-103
SALISBURY NC
28147-1162
US

IV. Provider business mailing address

1910 JAKE ALEXANDER BLVD W SUITE 102-103
SALISBURY NC
28147-1162
US

V. Phone/Fax

Practice location:
  • Phone: 704-633-7213
  • Fax: 704-636-4483
Mailing address:
  • Phone: 704-633-7213
  • Fax: 704-636-4483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHC0357
License Number StateNC

VIII. Authorized Official

Name: MR. NICK ELLEDGE
Title or Position: VICE PRESIDENT
Credential:
Phone: 336-679-8852