Provider Demographics
NPI:1558730184
Name:COMFORT KEEPERS HOME CARE SERVICE
Entity Type:Organization
Organization Name:COMFORT KEEPERS HOME CARE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NAKIA
Authorized Official - Middle Name:ANTRECE'
Authorized Official - Last Name:FLACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-671-8568
Mailing Address - Street 1:190 S SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28052-4125
Mailing Address - Country:US
Mailing Address - Phone:704-671-8568
Mailing Address - Fax:
Practice Address - Street 1:190 S SOUTH ST
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28052-4125
Practice Address - Country:US
Practice Address - Phone:704-671-8568
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-24
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health