Healthcare Provider Details

I. General information

NPI: 1124535893
Provider Name (Legal Business Name): KH COMPASSIONATE HEARTS HOME HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2018
Last Update Date: 01/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4509 LASLEY DR
WINSTON SALEM NC
27105-3116
US

IV. Provider business mailing address

4509 LASLEY DR
WINSTON SALEM NC
27105-3116
US

V. Phone/Fax

Practice location:
  • Phone: 336-986-4642
  • Fax:
Mailing address:
  • Phone: 336-986-4642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: HANA T CARSON
Title or Position: MANAGING MEMBER
Credential: BSN, RN
Phone: 336-682-0306