MEDICARE: HOME SUITE HOME CARE 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
1	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1356279129
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOME SUITE HOME CARE LLC

Provider Business Mailing Address
First Line	:	3425 TINLEY PARK DR
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27107-5605
Country	:	US
Telephone Number	:	336-918-5952
Fax Number	:

Provider Business Practice Location Address
First Line	:	3425 TINLEY PARK DR
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27107-5605
Country	:	US
Telephone Number	:	336-918-5952
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SHAQUALLA TYSHON MCINTYRE
Credential	:
Telephone Number	:	336-918-5952

Provider Enumeration Date	:	05/12/2026
Last Update Date	:	05/12/2026

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Directions to “HOME SUITE HOME CARE LLC ” Practice Location

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