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General NPI Number Information
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NPI Number | 1093079253
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Entity Type | Organization
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Legal Business Name | CHG-PCS SALISBURY
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Dates
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Enumeration Date | 07/02/2012
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Last Update Date | 07/02/2012
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Provider Practice Location Address
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Address Line | 909 S MAIN ST
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City | SALISBURY
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State | NC
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Zip | 28144-6416
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Country | US
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Telephone | 704-720-0668
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Fax | 704-720-0669
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Provider Business Mailing Address
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Address Line | PO BOX 554
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City | SALISBURY
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State | NC
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Zip | 28145-0554
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Country | US
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Telephone | 704-720-0668
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. TIMOTHY FONVILLE
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Credential |
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Telephone | 704-267-6324
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | HC3919
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License Number State | NC
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