MEDICARE: AT HOME SENIOR CARE OF AMERICA, 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1376287631
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AT HOME SENIOR CARE OF AMERICA, LLC

Provider Business Mailing Address
First Line	:	5695 NEW AVEDON DR
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27455-8399
Country	:	US
Telephone Number	:	336-508-3642
Fax Number	:

Provider Business Practice Location Address
First Line	:	5695 NEW AVEDON DR
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27455-8399
Country	:	US
Telephone Number	:	336-508-3642
Fax Number	:

Authorized Official
Title or Position	:	AGENCY DIRECTOR
Name	:	PEACE DZIGDORDI DORMON
Credential	:	HC PRACTITIONER
Telephone Number	:	336-508-3642

Provider Enumeration Date	:	04/23/2022
Last Update Date	:	05/06/2022

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