1255615746 NPI number — IN HOME HEALTHCARE PROFESSIONALS

Table of content: SAMANTHA JANE MCKENZIE BA (NPI 1477908812)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255615746 NPI number — IN HOME HEALTHCARE PROFESSIONALS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IN HOME HEALTHCARE PROFESSIONALS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255615746
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/04/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1811 SARDIS RD N
Provider Second Line Business Mailing Address:
220
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28270-1426
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-847-2898
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1811 SARDIS RD N
Provider Second Line Business Practice Location Address:
220
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28270-1426
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-847-2898
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/04/2011

Additional Information

Authorized Official

Authorized Official Last Name:
REDIC
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
GAIUS
Authorized Official Title or Position:
AGENCY DIRECTOR
Authorized Official Telephone Number:
704-756-7251

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X , with the licence number:  HC4455 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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