Provider Demographics
NPI:1144578428
Name:PIEDMONTH HEALTH SENIORCARE
Entity Type:Organization
Organization Name:PIEDMONTH HEALTH SENIORCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN CARE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TENESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDLIN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:336-532-0000
Mailing Address - Street 1:1214 VAUGHN RD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27217-2863
Mailing Address - Country:US
Mailing Address - Phone:336-532-0000
Mailing Address - Fax:
Practice Address - Street 1:1214 VAUGHN RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27217-2863
Practice Address - Country:US
Practice Address - Phone:336-532-0000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PIEDMONT HEALTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-17
Last Update Date:2012-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC190491251T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization