Provider Demographics
NPI:1558937797
Name:EMMANUEL HOMED CARE SERVICES
Entity Type:Organization
Organization Name:EMMANUEL HOMED CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:LEONORA
Authorized Official - Middle Name:NAAYI
Authorized Official - Last Name:MENSAH
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:917-362-1797
Mailing Address - Street 1:3623 LATROBE DR # 110-A3
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-4864
Mailing Address - Country:US
Mailing Address - Phone:980-236-8638
Mailing Address - Fax:704-595-3434
Practice Address - Street 1:3623 LATROBE DR # 110-A3
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-4864
Practice Address - Country:US
Practice Address - Phone:980-236-8638
Practice Address - Fax:704-595-3434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-28
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNONEMedicaid