=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427858562
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMFORT CORNER HOME CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/17/2025
-----------------------------------------------------
Last Update Date | 03/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 316 UNION HEIGHTS BLVD
-----------------------------------------------------
City | SALISBURY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28146-5942
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 980-439-0520
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 195 COOPER CREEK DR STE 101
-----------------------------------------------------
City | MOCKSVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27028-5968
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 980-439-0520
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DEASIA JONES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 980-439-0520
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------