Provider Demographics
NPI:1235592163
Name:COMFORT CARE PDS, LLC.
Entity Type:Organization
Organization Name:COMFORT CARE PDS, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LATINA
Authorized Official - Middle Name:
Authorized Official - Last Name:INGELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:980-282-0199
Mailing Address - Street 1:400 GILEAD RD
Mailing Address - Street 2:PO BOX 841
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28070-6953
Mailing Address - Country:US
Mailing Address - Phone:980-282-0199
Mailing Address - Fax:
Practice Address - Street 1:11522 LEIGH GLEN CIR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-3172
Practice Address - Country:US
Practice Address - Phone:980-282-0199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-29
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care