1104145051 NPI number — PROSPECT HOME CARE SERVICES,LLC

Table of content: DR. EMILY PETERMAN CABANO PH.D. (NPI 1871303008)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104145051 NPI number — PROSPECT HOME CARE SERVICES,LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROSPECT HOME CARE SERVICES,LLC
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:
1104145051
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/14/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
685 NORTH CANNON BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KANNAPOLIS
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28083-3778
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-934-2330
Provider Business Mailing Address Fax Number:
704-934-2335

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
685 NORTH CANNON BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KANNAPOLIS
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28083-3778
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-934-2330
Provider Business Practice Location Address Fax Number:
704-934-2335
Provider Enumeration Date:
05/18/2010

Additional Information

Authorized Official

Authorized Official Last Name:
BEDU
Authorized Official First Name:
HELEN
Authorized Official Middle Name:
I
Authorized Official Title or Position:
AGENCY DIRECTOR
Authorized Official Telephone Number:
704-934-2330

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  HC3981 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251J00000X , with the licence number: HC3981 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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