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NPI Code Detail

MEDICARE: PROFESSIONAL CARE HOME HEALTH SERVICES

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
1332B00000XDurable Medical Equipment & Medical Supplies

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1789456OTHERNCDME

General Provider Information

NPI Number : 1871745919
Entity Type Code : Organization
Provider Name (Legal Business Name) : PROFESSIONAL CARE HOME HEALTH SERVICES
Provider Business Mailing Address
First Line : 3137 AMITY CT
Second Line : SUITE 400
City : CHARLOTTE
State : NC
Zip : 28215-4935
Country : US
Telephone Number : 704-536-7326
Fax Number :
Provider Business Practice Location Address
First Line : 3137 AMITY CT
Second Line : SUITE 400
City : CHARLOTTE
State : NC
Zip : 28215-4935
Country : US
Telephone Number : 704-536-7326
Fax Number :
Authorized Official
Title or Position : ADMINISTRATOR
Name : TERESIA MEDLEY
Credential :
Telephone Number : 704-536-7326
Provider Enumeration Date : 10/21/2008
Last Update Date : 10/21/2008

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Directions to “PROFESSIONAL CARE HOME HEALTH SERVICES ” Practice Location

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