Provider Demographics
NPI:1164664009
Name:HOME CARE PROFESSIONALS
Entity Type:Organization
Organization Name:HOME CARE PROFESSIONALS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:STALLWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-448-1969
Mailing Address - Street 1:2502 ALBATROSS LN
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28104-3430
Mailing Address - Country:US
Mailing Address - Phone:803-448-1969
Mailing Address - Fax:
Practice Address - Street 1:339 E MAIN ST
Practice Address - Street 2:SUITE 203
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-5367
Practice Address - Country:US
Practice Address - Phone:803-448-1969
Practice Address - Fax:803-746-7748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-24
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No333300000XSuppliersEmergency Response System Companies