=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467902841
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOME WITH YOU COMPANION CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/10/2016
-----------------------------------------------------
Last Update Date | 10/10/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10004 FARM POND RD
-----------------------------------------------------
City | INDIAN TRAIL
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28079-5787
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-668-7319
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10004 FARM POND RD
-----------------------------------------------------
City | INDIAN TRAIL
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28079-5787
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-668-7319
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. WONONA MICHELLE LEWIS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 704-668-7319
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 302F00000X
-----------------------------------------------------
Taxonomy Name | Exclusive Provider Organization
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------