=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295019438
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VILLAGESTAFFING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/06/2011
-----------------------------------------------------
Last Update Date | 10/06/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1902 N SANDHILLS BLVD STE D
-----------------------------------------------------
City | ABERDEEN
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28315-2347
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-725-0342
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1902 N SANDHILLS BLVD STE D
-----------------------------------------------------
City | ABERDEEN
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28315-2347
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-725-0342
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | LAUREL SMITH
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 910-725-0342
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | HC4446
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------