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General NPI Number Information
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NPI Number | 1598181430
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Entity Type | Organization
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Legal Business Name | SERVANT'S HEART
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Dates
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Enumeration Date | 03/17/2014
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Last Update Date | 03/18/2014
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Provider Practice Location Address
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Address Line | 1921 NEW GARDEN RD APT K107
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City | GREENSBORO
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State | NC
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Zip | 27410-2250
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Country | US
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Telephone | 336-282-9025
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Fax |
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Provider Business Mailing Address
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Address Line | 532 N REGIONAL RD STE E
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City | GREENSBORO
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State | NC
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Zip | 27409-9057
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Country | US
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Telephone | 336-286-6400
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Fax | 336-664-1212
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Authorized Official
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Title or Position | DIRECTOR/QP
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Name | GINA TANNER
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Credential |
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Telephone | 336-286-6400
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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 | MHL-041-773
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License Number State | NC
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