=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376144683
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EMINENT CARING HANDS,LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/03/2020
-----------------------------------------------------
Last Update Date | 11/05/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1501 BROOKFORD RD
-----------------------------------------------------
City | KERNERSVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27284-9456
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-347-9013
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 200 SHADY LN APT 204
-----------------------------------------------------
City | BERMUDA RUN
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27006-8810
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-493-0250
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KENDRA CHAMBERS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 336-493-0250
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 374U00000X
-----------------------------------------------------
Taxonomy Name | Home Health Aide
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------