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General NPI Number Information
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NPI Number | 1528473436
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Entity Type | Organization
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Legal Business Name | PSALM 91-11 LLC
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Dates
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Enumeration Date | 06/30/2014
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Last Update Date | 06/30/2014
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Provider Practice Location Address
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Address Line | 100 N MAIN ST SUITE 212
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City | BELMONT
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State | NC
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Zip | 28012-3104
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Country | US
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Telephone | 704-825-3350
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Fax | 704-825-3355
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Provider Business Mailing Address
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Address Line | PO BOX 145
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City | BELMONT
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State | NC
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Zip | 28012-0145
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Country | US
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Telephone | 704-825-3350
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Fax | 704-825-3355
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | DIANE HANCOCK
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Credential |
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Telephone | 704-825-3350
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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 | HC4354
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License Number State | NC
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