MEDICARE: PROFESSIONAL CARE HOME HEALTH SERVICES

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	171M00000X	Case Manager/Care Coordinator

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	:	1528107414
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL CARE HOME HEALTH SERVICES

Provider Business Mailing Address
First Line	:	3126 MILTON RD
Second Line	:	SUITE 217
City	:	CHARLOTTE
State	:	NC
Zip	:	28215-3778
Country	:	US
Telephone Number	:	704-536-7326
Fax Number	:	704-536-7147

Provider Business Practice Location Address
First Line	:	3126 MILTON RD
Second Line	:	SUITE 217
City	:	CHARLOTTE
State	:	NC
Zip	:	28215-3778
Country	:	US
Telephone Number	:	704-536-7326
Fax Number	:	704-536-7147

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

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	08/22/2020

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Directions to “PROFESSIONAL CARE HOME HEALTH SERVICES ” Practice Location

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