Healthcare Provider Details

I. General information

NPI: 1679687156
Provider Name (Legal Business Name): PARKVIEW IN HOME AIDE SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 11/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 WESTOVER DR
SANFORD NC
27331-4057
US

IV. Provider business mailing address

PO BOX 4057
SANFORD NC
27331-4057
US

V. Phone/Fax

Practice location:
  • Phone: 919-775-1853
  • Fax: 919-774-6482
Mailing address:
  • Phone: 919-775-1853
  • Fax: 919-774-6482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberHC1034
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberHC1034
License Number StateNC

VIII. Authorized Official

Name: LINDA KELLER KELLY
Title or Position: PRESIDENT
Credential: RN
Phone: 919-775-1853