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General NPI Number Information
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NPI Number | 1598403289
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Entity Type | Organization
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Legal Business Name | SEDARIDGE HOMECARE AND STAFFING LLC
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Dates
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Enumeration Date | 05/24/2022
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Last Update Date | 05/24/2022
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Provider Practice Location Address
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Address Line | 611 SUMMIT AVE STE 14
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City | GREENSBORO
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State | NC
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Zip | 27405-7746
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Country | US
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Telephone | 336-508-7724
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Fax |
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Provider Business Mailing Address
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Address Line | 5206 SILVERBROOK DR
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City | MC LEANSVILLE
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State | NC
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Zip | 27301-9289
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Country | US
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Telephone | 336-508-7724
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ENE AJIBOLA
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Credential | NP
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Telephone | 336-508-7724
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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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Taxonomy #2
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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