1629757794 NPI number — ROBIN LOUISE LONG HOME HEALTH CARE

Table of content: ROBIN LOUISE LONG HOME HEALTH CARE (NPI 1629757794)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629757794 NPI number — ROBIN LOUISE LONG HOME HEALTH CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LONG
Provider First Name:
ROBIN
Provider Middle Name:
LOUISE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
HOME HEALTH CARE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LONG
Provider Other First Name:
ROBIN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MOUNT PLEASANT HOME
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1629757794
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/14/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8582 PARK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNT PLEASANT
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28124-8402
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-431-0410
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1507 PINTO PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT PLEASANT
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28124-8827
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
980-319-7592
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/14/2023

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 374U00000X , with the licence number:  HC6451 , 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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