NPIMap

Organization Active NPI

Professional Care Home Health Servi

  • Case Manager/Care Coordinator
  • Winston Salem, NC
National Provider Identifier
1467505305
Registry record updated Jun 25, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Case Manager/Care CoordinatorTaxonomy code 171M00000X
Legal business name
PROFESSIONAL CARE HOME HEALTH SERVI
Practice address
2070 Cloverdale Ave
Suite C
Winston-Salem, NC 27103
Phone
(336) 725-0755
NPI assigned
Jan 22, 2007
Last updated
Jun 25, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Teresia Medley, MSW
Title
Administrator
Phone
(336) 725-0755

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Case Manager/Care Coordinator 171M00000X NU Primary

Addresses

Primary practice location

2070 Cloverdale Ave
Suite C
Winston-Salem, NC 27103

Mailing address

2070 Cloverdale Ave
Suite C
Winston-Salem, NC 27103
Phone (336) 725-0755

Other identifiers 1

IdentifierTypeStateIssuer
8700436MedicaidNC

National Provider Directory

National Provider Directory
Tax ID family
Professional Care Home Health Services11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2070 Cloverdale Ave
Unit C
Winston Salem, NC 27103
Phone (336) 725-0755

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214352000000",
    "number": "1467505305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2070 CLOVERDALE AVE",
            "address_2": "SUITE C",
            "city": "WINSTON-SALEM",
            "state": "NC",
            "postal_code": "27103",
            "telephone_number": "336-725-0755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2070 CLOVERDALE AVE",
            "address_2": "SUITE C",
            "city": "WINSTON-SALEM",
            "state": "NC",
            "postal_code": "27103",
            "telephone_number": "336-725-0755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL CARE HOME HEALTH SERVI",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-22",
        "last_updated": "2008-06-25",
        "status": "A",
        "authorized_official_last_name": "MEDLEY",
        "authorized_official_first_name": "TERESIA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "336-725-0755",
        "authorized_official_credential": "MSW"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8700436",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.