Provider Demographics
NPI:1386653202
Name:UPPER LEVEL HOME CARE & PERSONAL CARE SERVICES,LLC
Entity Type:Organization
Organization Name:UPPER LEVEL HOME CARE & PERSONAL CARE SERVICES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JESSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLY-HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:RN,FNP
Authorized Official - Phone:336-659-1901
Mailing Address - Street 1:3455 POLO RD STE 108
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-4828
Mailing Address - Country:US
Mailing Address - Phone:336-659-1901
Mailing Address - Fax:336-768-1860
Practice Address - Street 1:3455 POLO RD STE 108
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-4828
Practice Address - Country:US
Practice Address - Phone:336-659-1901
Practice Address - Fax:336-768-1860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3179251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6601396Medicaid