MEDICARE: VANNA CARE INC

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	HC4353	NC

General Provider Information

NPI Number	:	1467713917
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VANNA CARE INC

Provider Business Mailing Address
First Line	:	172 W INDEPENDENCE BLVD
Second Line	:
City	:	MOUNT AIRY
State	:	NC
Zip	:	27030-3566
Country	:	US
Telephone Number	:	336-789-4472
Fax Number	:

Provider Business Practice Location Address
First Line	:	172 W INDEPENDENCE BLVD
Second Line	:
City	:	MOUNT AIRY
State	:	NC
Zip	:	27030-3566
Country	:	US
Telephone Number	:	336-789-4472
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. VAN LANKFORD
Credential	:
Telephone Number	:	336-789-4472

Provider Enumeration Date	:	05/31/2012
Last Update Date	:	05/31/2012

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