Provider Demographics
NPI:1558680041
Name:AZORA HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:AZORA HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MBAMALU
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:704-965-4946
Mailing Address - Street 1:135 MANOR AVE SW STE A
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-6715
Mailing Address - Country:US
Mailing Address - Phone:704-965-4946
Mailing Address - Fax:704-793-1127
Practice Address - Street 1:135 MANOR AVE SW STE A
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-6715
Practice Address - Country:US
Practice Address - Phone:704-965-4946
Practice Address - Fax:704-793-1127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-23
Last Update Date:2010-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HC4025251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health