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General NPI Number Information
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NPI Number | 1376287631
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Entity Type | Organization
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Legal Business Name | AT HOME SENIOR CARE OF AMERICA, LLC
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Dates
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Enumeration Date | 04/23/2022
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Last Update Date | 05/06/2022
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Provider Practice Location Address
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Address Line | 5695 NEW AVEDON DR
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City | GREENSBORO
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State | NC
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Zip | 27455-8399
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Country | US
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Telephone | 336-508-3642
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Fax |
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Provider Business Mailing Address
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Address Line | 5695 NEW AVEDON DR
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City | GREENSBORO
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State | NC
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Zip | 27455-8399
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Country | US
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Telephone | 336-508-3642
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Fax |
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Authorized Official
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Title or Position | AGENCY DIRECTOR
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Name | PEACE DZIGDORDI DORMON
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Credential | HC PRACTITIONER
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Telephone | 336-508-3642
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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