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General NPI Number Information
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NPI Number | 1588955223
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL HOME CARE OF NC
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Dates
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Enumeration Date | 04/28/2011
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Last Update Date | 02/13/2013
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Provider Practice Location Address
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Address Line | 315 BADGER CT
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City | FAYETTEVILLE
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State | NC
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Zip | 28303-3121
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Country | US
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Telephone | 919-523-7659
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Fax | 910-867-4955
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Provider Business Mailing Address
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Address Line | PO BOX 27893
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City | FAYETTEVILLE
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State | NC
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Zip | 28314-5048
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Country | US
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Telephone | 919-523-7659
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Fax | 910-867-4955
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. YOLANDA BAKER
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Credential |
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Telephone | 919-523-7659
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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 | HC4395
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License Number State | NC
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