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General NPI Number Information
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NPI Number | 1568077485
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Entity Type | Organization
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Legal Business Name | PMP HOME CARE AGENCY INC
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Dates
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Enumeration Date | 09/09/2020
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Last Update Date | 09/09/2020
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Provider Practice Location Address
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Address Line | 5329 YADKIN RD STE B
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City | FAYETTEVILLE
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State | NC
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Zip | 28303-3254
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Country | US
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Telephone | 910-850-6631
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1497
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City | FAYETTEVILLE
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State | NC
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Zip | 28302-1497
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | YVETTE BULLOCK
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Credential |
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Telephone | 910-850-6631
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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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