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General NPI Number Information
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NPI Number | 1922494426
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Entity Type | Organization
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Legal Business Name | RELIANCE HEALTH SOURCE LLC
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Dates
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Enumeration Date | 04/10/2015
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Last Update Date | 04/10/2015
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Provider Practice Location Address
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Address Line | 2 TERRACE WAY STE D BOX #10
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City | GREENSBORO
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State | NC
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Zip | 27403-3663
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Country | US
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Telephone | 336-844-4684
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Fax | 336-740-9342
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Provider Business Mailing Address
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Address Line | 2 TERRACE WAY STE D BOX #10
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City | GREENSBORO
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State | NC
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Zip | 27403-3663
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Country | US
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Telephone | 336-844-4684
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Fax | 336-740-9342
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | TAMARA A ASAD
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Credential |
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Telephone | 336-844-4684
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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 | HC6442
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License Number State | NC
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