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General NPI Number Information
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NPI Number | 1104185255
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Entity Type | Organization
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Legal Business Name | DEDICATED HOME CARE, INC
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Dates
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Enumeration Date | 05/10/2012
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Last Update Date | 05/10/2012
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Provider Practice Location Address
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Address Line | 1910 BIG MILL RD
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City | WILLIAMSTON
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State | NC
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Zip | 27892-7533
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Country | US
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Telephone | 954-479-9856
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Fax |
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Provider Business Mailing Address
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Address Line | 4173 HEARTHSIDE DR 104
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City | WILMINGTON
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State | NC
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Zip | 28412-8539
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Country | US
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Telephone | 954-479-9856
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Fax |
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Authorized Official
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Title or Position | BUS MANAGER
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Name | JOHNATHAUN LEE
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Credential |
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Telephone | 954-479-9856
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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 | HC4391
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License Number State | NC
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