Provider Demographics
NPI:1558403915
Name:LANDRUM, INC.
Entity Type:Organization
Organization Name:LANDRUM, INC.
Other - Org Name:VISITING ANGELS OF MOORESVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:LANDRUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-663-1065
Mailing Address - Street 1:542 WILLIAMSON RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-8193
Mailing Address - Country:US
Mailing Address - Phone:704-663-1065
Mailing Address - Fax:704-660-1851
Practice Address - Street 1:542 WILLIAMSON RD
Practice Address - Street 2:SUITE 5
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8193
Practice Address - Country:US
Practice Address - Phone:704-663-1065
Practice Address - Fax:704-660-1851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3210251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3418114Medicaid
NC6601413Medicaid