Healthcare Provider Details

I. General information

NPI: 1659636173
Provider Name (Legal Business Name): MARICKEYO S HUSKEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2012
Last Update Date: 09/21/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 LESLIE DR
SHELBY NC
28152-0758
US

IV. Provider business mailing address

208 LESLIE DR
SHELBY NC
28152-0758
US

V. Phone/Fax

Practice location:
  • Phone: 704-600-6480
  • Fax: 704-466-3043
Mailing address:
  • Phone: 704-600-6480
  • Fax: 704-466-3043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number StateNC

VIII. Authorized Official

Name: MR. MARICKEYO S HUSKEY
Title or Position: OWNER/ADMINISTRATOR
Credential:
Phone: 864-491-9081