Provider Demographics
NPI:1881780658
Name:RESILIENCE HEALTH CARE
Entity type:Organization
Organization Name:RESILIENCE HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-CEO
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:704-497-6131
Mailing Address - Street 1:1312 MATTHEWS MINT HILL RD STE 206
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-4212
Mailing Address - Country:US
Mailing Address - Phone:704-841-2482
Mailing Address - Fax:
Practice Address - Street 1:1312 MATTHEWS MINT HILL RD STE 206
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-4212
Practice Address - Country:US
Practice Address - Phone:704-841-2482
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3371251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC037585OtherLPN STATE LICENSE
NC3418120Medicaid