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General NPI Number Information
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NPI Number | 1578893467
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Entity Type | Organization
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Legal Business Name | STAY AT HOME SENIOR CARE, LLC
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Dates
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Enumeration Date | 12/28/2009
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Last Update Date | 12/28/2009
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Provider Practice Location Address
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Address Line | 2014 S MAIN ST SUITE 610
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City | WAKE FOREST
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State | NC
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Zip | 27587-4339
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Country | US
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Telephone | 919-556-3706
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Fax |
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Provider Business Mailing Address
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Address Line | 2014 S MAIN ST SUITE 610
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City | WAKE FOREST
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State | NC
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Zip | 27587-4339
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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 | PRESIDENT
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Name | DEBORAH BORDEAUX
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Credential |
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Telephone | 919-556-3706
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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 | 230375126
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License Number State | NC
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