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General NPI Number Information
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NPI Number | 1760740922
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Entity Type | Organization
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Legal Business Name | AMANI HOME CARE, LLC
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Dates
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Enumeration Date | 04/25/2012
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Last Update Date | 04/25/2012
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Provider Practice Location Address
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Address Line | 8025 N POINT BLVD SUITE 230
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City | WINSTON SALEM
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State | NC
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Zip | 27106-3262
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Country | US
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Telephone | 336-293-6666
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Fax |
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Provider Business Mailing Address
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Address Line | 8025 N POINT BLVD SUITE 230
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City | WINSTON SALEM
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State | NC
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Zip | 27106-3262
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Country | US
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Telephone | 336-293-6666
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. TIMOTHY WAYNE GUPTON JR.
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Credential |
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Telephone | 336-293-6666
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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 |
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License Number State | NC
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