NPIMap

Organization Active NPI

Professional Care Home Health Services

  • Nurse's Aide
  • Winston-Salem, NC
National Provider Identifier
1750434635
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse's AideTaxonomy code 376K00000X
License
HC2948 Issued in NC
Legal business name
PROFESSIONAL CARE HOME HEALTH SERVICES
Practice address
2070 Cloverdale Ave.
Suite C
Winston-Salem, NC 27103
Phone
(336) 725-0755
NPI assigned
Jan 22, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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
(704) 536-7326

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse's AideGroup: 193400000X SINGLE SPECIALTY GROUP 376K00000X HC2948 NC 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
6601252MedicaidNC

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.

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": "1598054400000",
    "number": "1750434635",
    "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 SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MEDLEY",
        "authorized_official_first_name": "TERESIA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "704-536-7326",
        "authorized_official_credential": "MSW"
    },
    "taxonomies": [
        {
            "code": "376K00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse's Aide",
            "state": "NC",
            "license": "HC2948",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6601252",
            "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 Aug 22, 2020; 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.