MEDICARE: A GREAT CHOICE FOR HOME CARE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide
2	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1073150975
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A GREAT CHOICE FOR HOME CARE, INC.

Provider Business Mailing Address
First Line	:	1671 WELLONS DR
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28304-5054
Country	:	US
Telephone Number	:	919-396-1222
Fax Number	:	910-339-0237

Provider Business Practice Location Address
First Line	:	626 MABEL ST
Second Line	:
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44502-2226
Country	:	US
Telephone Number	:	919-396-1222
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DINEZ BAKER
Credential	:
Telephone Number	:	919-396-1222

Provider Enumeration Date	:	12/10/2019
Last Update Date	:	01/30/2020

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