Healthcare Provider Details

I. General information

NPI: 1366727265
Provider Name (Legal Business Name): WITH LOVING CARE HOME HEALTH CARE AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2011
Last Update Date: 10/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1065 SWAIM WOODS LN
WINSTON SALEM NC
27107-5461
US

IV. Provider business mailing address

1065 SWAIM WOODS LN
WINSTON SALEM NC
27107-5461
US

V. Phone/Fax

Practice location:
  • Phone: 336-793-6007
  • Fax:
Mailing address:
  • Phone: 336-793-6007
  • 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 Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: MRS. MONIQUE LADOSCA MOCK
Title or Position: CLINICAL SPECIALIST
Credential: NURSING ASSISTANT
Phone: 13367936007