Healthcare Provider Details

I. General information

NPI: 1356279129
Provider Name (Legal Business Name): HOME SUITE HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3425 TINLEY PARK DR
WINSTON SALEM NC
27107-5605
US

IV. Provider business mailing address

3425 TINLEY PARK DR
WINSTON SALEM NC
27107-5605
US

V. Phone/Fax

Practice location:
  • Phone: 336-918-5952
  • Fax:
Mailing address:
  • Phone: 336-918-5952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: SHAQUALLA TYSHON MCINTYRE
Title or Position: OWNER
Credential:
Phone: 336-918-5952