Provider Demographics
NPI:1417626995
Name:METROLINA HOME CARE
Entity Type:Organization
Organization Name:METROLINA HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAMILA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUMINOVA
Authorized Official - Suffix:
Authorized Official - Credentials:CSCM
Authorized Official - Phone:704-585-8485
Mailing Address - Street 1:6201 FAIRVIEW RD STE 200
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3297
Mailing Address - Country:US
Mailing Address - Phone:704-585-8485
Mailing Address - Fax:
Practice Address - Street 1:6201 FAIRVIEW RD STE 200
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-3297
Practice Address - Country:US
Practice Address - Phone:704-585-8485
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care