Provider Demographics
NPI:1407878382
Name:PROFESSIONAL CARE HOME HEALTH SERVICES
Entity Type:Organization
Organization Name:PROFESSIONAL CARE HOME HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TERESIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MEDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:704-536-7326
Mailing Address - Street 1:3126 MILTON RD
Mailing Address - Street 2:SUITE 217
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-3778
Mailing Address - Country:US
Mailing Address - Phone:704-536-7326
Mailing Address - Fax:704-536-7147
Practice Address - Street 1:3126 MILTON RD
Practice Address - Street 2:SUITE 217
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-3778
Practice Address - Country:US
Practice Address - Phone:704-536-7326
Practice Address - Fax:704-536-7147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6601390Medicaid