Provider Demographics
NPI:1922392612
Name:1ST IN PROACTIVE CARE LLC
Entity Type:Organization
Organization Name:1ST IN PROACTIVE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CECILY
Authorized Official - Middle Name:CROFOOT
Authorized Official - Last Name:HOOKS
Authorized Official - Suffix:
Authorized Official - Credentials:CSA
Authorized Official - Phone:336-992-2292
Mailing Address - Street 1:815 OLD WINSTON RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-7124
Mailing Address - Country:US
Mailing Address - Phone:336-992-2292
Mailing Address - Fax:800-315-1585
Practice Address - Street 1:815 OLD WINSTON RD
Practice Address - Street 2:SUITE E
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-7124
Practice Address - Country:US
Practice Address - Phone:336-992-2292
Practice Address - Fax:800-315-1585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-31
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC4376253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care