Healthcare Provider Details

I. General information

NPI: 1851869457
Provider Name (Legal Business Name): ST. SIMEON AND LOUISA HOME HEALTH CARE AGENCY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2018
Last Update Date: 11/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 W INNES ST UPPR LEVEL
SALISBURY NC
28144-4152
US

IV. Provider business mailing address

1707 NANTUCKETT LN APT 108
CHARLOTTE NC
28270-3311
US

V. Phone/Fax

Practice location:
  • Phone: 980-242-7226
  • Fax:
Mailing address:
  • Phone: 980-242-7226
  • Fax:

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: MS. CYNTHIA NONYELUM OKWARA
Title or Position: OWNER/CEO
Credential: BSC., MBA
Phone: 704-681-2581