Renita Kirkman

Individual provider Active NPI In Home Supportive Care Agency · Grantsboro, NC

NPI 1164058186 · NPPES record last updated Mar 21, 2020

Key facts

NPI
1164058186
Entity type
Individual (NPI type 1)
Primary specialty
In Home Supportive Care Agency 253Z00000X
License
HC5411 (NC)
Practice address
11560 NC 55 Hwy Ste 7
Grantsboro, NC 28529-9447
Phone
(252) 242-0088
NPI assigned
Mar 21, 2020
Sex
Female
Sole proprietor
Yes

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
HC5411NCMDIn Home Supportive Care Agency

Practice roles

OrganizationSpecialtyStatusNew patients
Trinity Adult and Senior Services LLC In Home Supportive Care Current
since Mar 29, 2020
Accepting new patients
Cannon Ridge Diagnostic, LLC Current
since Jul 5, 2020
Accepting new patients

Locations

11560 NC 55 Hwy
Ste 7
Grantsboro, NC 28529
Phone (252) 242-0088

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
In Home Supportive Care Agency 253Z00000X HC5411 NC Yes

Addresses

Primary practice location

11560 NC 55 Hwy Ste 7
Grantsboro, NC 28529-9447

Mailing address

11560 NC 55 Hwy Ste 7
Grantsboro, NC 28529-9447
Phone (252) 242-0088

Other providers in Grantsboro, NC

All providers in Grantsboro, NC · In Home Supportive Care Agency in North Carolina

Sources for this page

Verify at the official NPI Registry.