Provider Demographics
NPI:1982856340
Name:PROFESSIONAL CARE HOME HEALTH SERVICES
Entity Type:Organization
Organization Name:PROFESSIONAL CARE HOME HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TERESIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-536-7326
Mailing Address - Street 1:3137 AMITY COURT
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215
Mailing Address - Country:US
Mailing Address - Phone:704-536-7326
Mailing Address - Fax:704-536-7147
Practice Address - Street 1:3137 AMITY COURT
Practice Address - Street 2:SUITE 400
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215
Practice Address - Country:US
Practice Address - Phone:704-536-7326
Practice Address - Fax:704-536-7147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0000000251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1234567OtherPDN