Provider Demographics
NPI:1275905762
Name:PHADALITY HOME CARE LLC
Entity Type:Organization
Organization Name:PHADALITY HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALANA
Authorized Official - Middle Name:D
Authorized Official - Last Name:LORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-941-0371
Mailing Address - Street 1:5104 REAGAN DR STE 13
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28206-1393
Mailing Address - Country:US
Mailing Address - Phone:980-858-2336
Mailing Address - Fax:
Practice Address - Street 1:5104 REAGAN DR STE 13
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28206-1393
Practice Address - Country:US
Practice Address - Phone:980-858-2336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-23
Last Update Date:2015-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3990251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1205224540Medicaid