Convenant Homecare Agency

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

License

167822 Issued in NC

Legal business name

CONVENANT HOMECARE AGENCY

Practice address

4221 Chatterleigh Dr
Monroe, NC 28110-8102

Phone

(704) 756-6553

NPI assigned

Feb 20, 2009

Last updated

Feb 20, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Preciouse Adula Wilson, RN,BSN,MBA/HCM

Title

Director/Owner

Phone

(704) 576-6553

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1235088000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1235088000000",
    "number": "1558501221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4221 CHATTERLEIGH DR",
            "city": "MONROE",
            "state": "NC",
            "postal_code": "281108102",
            "telephone_number": "704-756-6553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4221 CHATTERLEIGH DR",
            "city": "MONROE",
            "state": "NC",
            "postal_code": "281108102",
            "telephone_number": "704-756-6553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONVENANT HOMECARE AGENCY",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-20",
        "last_updated": "2009-02-20",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "PRECIOUSE",
        "authorized_official_middle_name": "ADULA",
        "authorized_official_title_or_position": "DIRECTOR/OWNER",
        "authorized_official_telephone_number": "704-576-6553",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RN,BSN,MBA/HCM"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "NC",
            "license": "167822",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2009; 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.