Provider Demographics
NPI:1083699607
Name:DUDLEY'S HOME HEALTH, INC.
Entity Type:Organization
Organization Name:DUDLEY'S HOME HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LONDA
Authorized Official - Middle Name:CARR
Authorized Official - Last Name:DUDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-799-3363
Mailing Address - Street 1:223 WILLIAMSON RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-6899
Mailing Address - Country:US
Mailing Address - Phone:704-799-3363
Mailing Address - Fax:704-799-3635
Practice Address - Street 1:223 WILLIAMSON RD
Practice Address - Street 2:SUITE 102
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-6899
Practice Address - Country:US
Practice Address - Phone:704-799-3363
Practice Address - Fax:704-799-3635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-07
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC2330251E00000X, 251F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7100183Medicaid
6696893OtherMSC CARE MANAGEMENT
NC3408727Medicaid