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General NPI Number Information
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NPI Number | 1093329864
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Entity Type | Organization
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Legal Business Name | GERVITA HOME CARE
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Dates
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Enumeration Date | 08/31/2020
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Last Update Date | 01/21/2022
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Provider Practice Location Address
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Address Line | 3868 WEST AVE APT E
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City | GREENSBORO
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State | NC
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Zip | 27407-4569
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Country | US
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Telephone | 984-369-4476
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Fax |
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Provider Business Mailing Address
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Address Line | 101 S ELM ST STE 23
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City | GREENSBORO
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State | NC
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Zip | 27401-2898
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Country | US
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Telephone | 984-261-5621
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | FRANCK ROMUAL KOMBOU SILE
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Credential | NURSING STUDENT
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Telephone | 984-261-5621
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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 |
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License Number State |
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