Provider Demographics
NPI:1689850521
Name:METROLINA HEALTH SUPPORT SERVICES
Entity Type:Organization
Organization Name:METROLINA HEALTH SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDAL
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:SYKES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:704-777-0969
Mailing Address - Street 1:2812 CROSS POINT CIRCLE #13
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-8343
Mailing Address - Country:US
Mailing Address - Phone:704-777-0969
Mailing Address - Fax:704-817-7920
Practice Address - Street 1:2812 CROSS POINT CIR APT 13
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-8343
Practice Address - Country:US
Practice Address - Phone:704-777-0969
Practice Address - Fax:704-817-7920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC117272251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care