MEDICARE: PROFESSIONAL CARE HOME HEALTH

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	332B00000X	Durable Medical Equipment & Medical Supplies

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	:	1417193855
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL CARE HOME HEALTH

Provider Business Mailing Address
First Line	:	3137 AMITY COURT
Second Line	:	SUITE 400
City	:	CHARLOTTE
State	:	NC
Zip	:	28215-5765
Country	:	US
Telephone Number	:	704-536-7326
Fax Number	:	704-536-7147

Provider Business Practice Location Address
First Line	:	3137 AMITY COURT
Second Line	:	SUITE 400
City	:	CHARLOTTE
State	:	NC
Zip	:	28215-5765
Country	:	US
Telephone Number	:	704-536-7326
Fax Number	:	704-536-7147

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	TERESIA MEDLEY
Credential	:
Telephone Number	:	704-536-7326

Provider Enumeration Date	:	01/06/2009
Last Update Date	:	01/06/2009

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Directions to “PROFESSIONAL CARE HOME HEALTH ” Practice Location

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