Provider Demographics
NPI:1497048417
Name:TABONO CAP SERVICES
Entity Type:Organization
Organization Name:TABONO CAP SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:D
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-892-1300
Mailing Address - Street 1:PO BOX 480428
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-5320
Mailing Address - Country:US
Mailing Address - Phone:704-892-1300
Mailing Address - Fax:704-892-1505
Practice Address - Street 1:16930 W CATAWBA AVE
Practice Address - Street 2:SUITE 100-C
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-5638
Practice Address - Country:US
Practice Address - Phone:704-892-1300
Practice Address - Fax:704-892-1505
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TABONO CARE SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-05-24
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC4110251E00000X, 3747A0650X, 3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3418923Medicaid