=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629757794
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBIN LOUISE LONG HOME HEALTH CARE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/14/2023
-----------------------------------------------------
Last Update Date | 07/14/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1507 PINTO PL
-----------------------------------------------------
City | MOUNT PLEASANT
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28124-8827
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 980-319-7592
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8582 PARK DR
-----------------------------------------------------
City | MOUNT PLEASANT
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28124-8402
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-431-0410
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 374U00000X
-----------------------------------------------------
Taxonomy Name | Home Health Aide
-----------------------------------------------------
License Number | HC6451
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------