Provider Demographics
NPI:1093362063
Name:MIND AND BODY HOME CARE
Entity Type:Organization
Organization Name:MIND AND BODY HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALAYA
Authorized Official - Middle Name:
Authorized Official - Last Name:BALLAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-778-3365
Mailing Address - Street 1:615 SAINT GEORGE SQUARE
Mailing Address - Street 2:STE 300
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-1368
Mailing Address - Country:US
Mailing Address - Phone:336-778-3365
Mailing Address - Fax:
Practice Address - Street 1:615 SAINT GEORGE SQUARE
Practice Address - Street 2:STE 300
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1368
Practice Address - Country:US
Practice Address - Phone:336-778-3365
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-23
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No385H00000XRespite Care FacilityRespite Care