Healthcare Provider Details

I. General information

NPI: 1568986800
Provider Name (Legal Business Name): TOP PRIORITY CARE SERVICES, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2017
Last Update Date: 08/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4625 STANLEY CT
WINSTON SALEM NC
27101
US

IV. Provider business mailing address

4401 PROVIDENCE LN
WINSTON SALEM NC
27106-3226
US

V. Phone/Fax

Practice location:
  • Phone: 336-777-7777
  • Fax: 336-896-1327
Mailing address:
  • Phone: 336-896-1323
  • Fax: 336-896-1327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberMHL-034-371
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateNC

VIII. Authorized Official

Name: MR. SHARON P. JOHNSON
Title or Position: CEO
Credential: LCSWA, LCASA
Phone: 336-896-1323