MEDICARE: CARESOUTH HHA HOLDINGS OF LEXINGTON 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	251E00000X	Home Health Agency	HC1104	NC

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
2	34D0884863	OTHER		CLIA

General Provider Information

NPI Number	:	1851379283
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARESOUTH HHA HOLDINGS OF LEXINGTON LLC

Provider Business Mailing Address
First Line	:	6688 N CENTRAL EXPRESSWAY
Second Line	:	SUITE 1300
City	:	DALLAS
State	:	TX
Zip	:	75206-3950
Country	:	US
Telephone Number	:	214-239-6500
Fax Number	:	214-239-6581

Provider Business Practice Location Address
First Line	:	729 VINEYARDS XING
Second Line	:
City	:	LEXINGTON
State	:	NC
Zip	:	27295-2076
Country	:	US
Telephone Number	:	336-249-7813
Fax Number	:	336-249-8018

Authorized Official
Title or Position	:	EVP OF HOME HEALTH OPERATIONS
Name	:	JULIE DIANE JOLLEY
Credential	:
Telephone Number	:	214-239-6500

Provider Enumeration Date	:	01/05/2006
Last Update Date	:	01/02/2025

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