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General NPI Number Information
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NPI Number | 1700969177
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Entity Type | Organization
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Legal Business Name | HOME CARE AT THE LAKE, INC
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Dates
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Enumeration Date | 10/21/2006
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Last Update Date | 12/04/2007
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Provider Practice Location Address
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Address Line | 470 N BROAD ST SUITE E
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City | MOORESVILLE
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State | NC
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Zip | 28115-3083
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Country | US
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Telephone | 704-662-9911
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Fax | 704-662-9080
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Provider Business Mailing Address
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Address Line | 470 N BROAD ST SUITE E
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City | MOORESVILLE
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State | NC
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Zip | 28115-3083
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Country | US
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Telephone | 704-662-9911
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Fax | 704-662-9080
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Authorized Official
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Title or Position | PRESIDENT/HOME CARE COORDINATOR
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Name | KAREN H SMITH
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Credential |
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Telephone | 704-662-9911
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | HC2245
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License Number State | NC
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