Provider Demographics
NPI:1003923897
Name:SYMAKLA HOME HEATLHCARE PROFESSIONALS OF NORTH CAROLINA
Entity Type:Organization
Organization Name:SYMAKLA HOME HEATLHCARE PROFESSIONALS OF NORTH CAROLINA
Other - Org Name:SYMAKLA HOME HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LASONYA
Authorized Official - Middle Name:S
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:704-947-8383
Mailing Address - Street 1:1909 J N PEASE PL
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-4558
Mailing Address - Country:US
Mailing Address - Phone:704-947-8383
Mailing Address - Fax:704-717-3168
Practice Address - Street 1:1909 J N PEASE PL
Practice Address - Street 2:SUITE 101
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-4558
Practice Address - Country:US
Practice Address - Phone:704-947-8383
Practice Address - Fax:704-717-3168
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SYMAKLA WATSON INVESTMENTS CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-25
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3420251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3418216OtherCAP/ DISABLED ADULT, CAP/ CHILDREN PROGRAMS, CAP/CHOICE
NC6601527Medicaid
NCHC3420OtherDFS LICENSE NUMBER