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General NPI Number Information
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NPI Number | 1942274097
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Entity Type | Organization
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Legal Business Name | TRADITIONAL LIVING HOME CARE INC.
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Dates
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Enumeration Date | 02/15/2006
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Last Update Date | 11/25/2009
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Provider Practice Location Address
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Address Line | 101 W MAIN ST
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City | WILKESBORO
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State | NC
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Zip | 28697-2422
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Country | US
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Telephone | 336-667-4546
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Fax | 336-667-2621
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Provider Business Mailing Address
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Address Line | 1550 OVERLOOK DR
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City | WILKESBORO
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State | NC
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Zip | 28697-2610
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Country | US
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Telephone | 336-667-6447
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Fax | 336-667-2621
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Authorized Official
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Title or Position | OWNER
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Name | MRS. LORI R GAUGHAN
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Credential |
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Telephone | 336-667-4546
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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 | HC2784
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License Number State | NC
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