Provider Demographics
NPI:1851869457
Name:ST. SIMEON AND LOUISA HOME HEALTH CARE AGENCY, LLC
Entity Type:Organization
Organization Name:ST. SIMEON AND LOUISA HOME HEALTH CARE AGENCY, LLC
Other - Org Name:S & L HOME CARE AGENCY, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:NONYELUM
Authorized Official - Last Name:OKWARA
Authorized Official - Suffix:
Authorized Official - Credentials:BSC, MBA
Authorized Official - Phone:704-681-2581
Mailing Address - Street 1:1707 NANTUCKETT LN APT 108
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28270-3311
Mailing Address - Country:US
Mailing Address - Phone:980-242-7226
Mailing Address - Fax:
Practice Address - Street 1:812 W INNES ST UPPR LEVEL
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-4152
Practice Address - Country:US
Practice Address - Phone:980-242-7226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-13
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care