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NPI Code Detail

MEDICARE: PEAM HOME HEALTHCARE AGENCY LLC

MEDICARE: PEAM HOME HEALTHCARE AGENCY LLC
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
1251E00000XHome Health Agency
2253Z00000XIn Home Supportive Care Agency

General Provider Information

NPI Number : 1356180764
Entity Type Code : Organization
Provider Name (Legal Business Name) : PEAM HOME HEALTHCARE AGENCY LLC
Provider Business Mailing Address
First Line : 1011 GRAYSCROFT DR
Second Line :
City : WAXHAW
State : NC
Zip : 28173-6652
Country : US
Telephone Number : 703-459-7141
Fax Number :
Provider Business Practice Location Address
First Line : 11709 FRUEHAUF DR
Second Line :
City : CHARLOTTE
State : NC
Zip : 28273-7284
Country : US
Telephone Number : 703-459-7141
Fax Number :
Authorized Official
Title or Position : AGENCY DIRECTOR
Name : JONES OSUAGWU
Credential :
Telephone Number : 703-459-7141
Provider Enumeration Date : 05/23/2024
Last Update Date : 05/23/2024

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Directions to “PEAM HOME HEALTHCARE AGENCY LLC ” Practice Location

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