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General NPI Number Information
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NPI Number | 1770160210
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Entity Type | Organization
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Legal Business Name | MGA HOME HEALTHCARE FAYETTEVILLE, LLC
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Dates
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Enumeration Date | 03/29/2021
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Last Update Date | 11/30/2023
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Provider Practice Location Address
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Address Line | 9101 KINGS PARADE BLVD SUITE 100
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City | CHARLOTTE
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State | NC
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Zip | 28273-4068
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Country | US
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Telephone | 704-200-9015
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Fax |
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Provider Business Mailing Address
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Address Line | 9101 KINGS PARADE BLVD SUITE 100
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City | CHARLOTTE
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State | NC
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Zip | 28273-4068
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Country | US
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Telephone | 704-200-9015
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Fax |
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Authorized Official
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Title or Position | VP CLINICAL OPERATIONS
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Name | MELODY BEATY
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Credential | MSN, RN
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Telephone | 704-200-9015
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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