=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093074148
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SPECIAL TOUCH AGENCY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/10/2012
-----------------------------------------------------
Last Update Date | 05/10/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 185 DIAMOND DR
-----------------------------------------------------
City | RED SPRINGS
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28377-8657
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-479-9856
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4173 HEARTHSIDE DR 104
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28412-8335
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BUS MANAGER
-----------------------------------------------------
Name | JOHNATHAUN LEE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 954-479-9856
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | HC4344
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------