Healthcare Provider Details

I. General information

NPI: 1528576600
Provider Name (Legal Business Name): DIGNITY IN-HOME CARE AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2018
Last Update Date: 01/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 ROCK SPRINGS CHURCH RD
RUBY SC
29741
US

IV. Provider business mailing address

5914 CRAFTSBURY DR
CHARLOTTE NC
28215-2336
US

V. Phone/Fax

Practice location:
  • Phone: 667-803-0701
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: STEPHANIE STEVENSON
Title or Position: OWNER
Credential:
Phone: 704-449-3070