Provider Demographics
NPI:1629757794
Name:LONG, ROBIN LOUISE (HOME HEALTH CARE)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:LOUISE
Last Name:LONG
Suffix:
Gender:F
Credentials:HOME HEALTH CARE
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:
Other - Last Name:LONG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MOUNT PLEASANT HOME
Mailing Address - Street 1:8582 PARK DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:NC
Mailing Address - Zip Code:28124-8402
Mailing Address - Country:US
Mailing Address - Phone:704-431-0410
Mailing Address - Fax:
Practice Address - Street 1:1507 PINTO PL
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:NC
Practice Address - Zip Code:28124-8827
Practice Address - Country:US
Practice Address - Phone:980-319-7592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-14
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC6451374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide