=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164170627
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRENDA JOHNSON TORAIN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/14/2022
-----------------------------------------------------
Last Update Date | 03/14/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 487 NORTH WASHINGTON AVENUE 487 NORTH WASHINGTON AVE
-----------------------------------------------------
City | REIDSVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27320
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-327-2507
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 200 CYPRESS CT
-----------------------------------------------------
City | GIBSONVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27249-2770
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-327-2507
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 374U00000X
-----------------------------------------------------
Taxonomy Name | Home Health Aide
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------