Healthcare Provider Details

I. General information

NPI: 1750007670
Provider Name (Legal Business Name): A GREAT CHOICE FOR HOME CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2022
Last Update Date: 10/12/2022
Certification Date: 10/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

626 MABEL ST
YOUNGSTOWN OH
44502-2226
US

IV. Provider business mailing address

626 MABEL ST
YOUNGSTOWN OH
44502-2226
US

V. Phone/Fax

Practice location:
  • Phone: 919-396-1222
  • Fax: 910-339-0237
Mailing address:
  • Phone: 919-396-1222
  • Fax: 910-339-0237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: DINEZ BAKER
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 919-396-1222