MEDICARE: PROFESSIONAL CARE HOME HEALTH SERVICES

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	251B00000X	Case Management Agency	00000	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235396466
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL CARE HOME HEALTH SERVICES

Provider Business Mailing Address
First Line	:	2070 CLOVERDALE AVE
Second Line	:	SUITE C
City	:	WINSTON-SALEM
State	:	NC
Zip	:	27103-2503
Country	:	US
Telephone Number	:	336-725-0755
Fax Number	:	336-725-0756

Provider Business Practice Location Address
First Line	:	3721 EASTWAY DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-6266
Country	:	US
Telephone Number	:	704-536-7326
Fax Number	:	704-536-7147

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. Y'LONDA JACKSON
Credential	:
Telephone Number	:	336-725-0755

Provider Enumeration Date	:	05/16/2008
Last Update Date	:	05/16/2008

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Directions to “PROFESSIONAL CARE HOME HEALTH SERVICES ” Practice Location

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