Provider Demographics
NPI:1417386103
Name:REASSURANCE HOME HEALTH AIDE
Entity Type:Organization
Organization Name:REASSURANCE HOME HEALTH AIDE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:FREDERICK
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:704-904-6246
Mailing Address - Street 1:4510 CHRISTENBURY HILLS LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-0980
Mailing Address - Country:US
Mailing Address - Phone:704-904-6246
Mailing Address - Fax:
Practice Address - Street 1:4510 CHRISTENBURY HILLS LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-0980
Practice Address - Country:US
Practice Address - Phone:704-904-6246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC406971311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2412454366Medicaid