Individual provider Active NPI

Funke Yenrin Amanah

  • In Home Supportive Care Agency
  • Charlotte, NC
National Provider Identifier
1780294389
Registry record updated Aug 7, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
In Home Supportive Care AgencyTaxonomy code 253Z00000X
License
HC5632 Issued in NC
Practice address
3555 N Sharon Amity Rd Ste 201
Charlotte, NC 28205-8993
Phone
(980) 498-2031
NPI assigned
Aug 7, 2020
Last updated
Aug 7, 2020By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 7, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
In Home Supportive Care Agency 253Z00000X
In Home Supportive Care Agency 253Z00000X HC5632 NC Primary

Addresses

Primary practice location

3555 N Sharon Amity Rd Ste 201
Charlotte, NC 28205-8993

Mailing address

3555 N Sharon Amity Rd
Charlotte, NC 28205-8935
Phone (980) 498-2031

Other identifiers 1

IdentifierTypeStateIssuer
HC5632MedicaidNC

Medicare participation

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

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
HC5632NCMDIn Home Supportive Care Agency

Practice roles

OrganizationSpecialtyStatusNew patients
Gifted Services LLC In Home Supportive Care CurrentSince Oct 25, 2020 Accepting new patients

Locations

3555 N Sharon Amity Rd
Charlotte, NC 28205
Phone (704) 536-8332

3555 N Sharon Amity Rd
Ste 201
Charlotte, NC 28205
Phone (773) 469-1576

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1596758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596758400000",
    "number": "1780294389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3555 N SHARON AMITY RD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282058935",
            "telephone_number": "980-498-2031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3555 N SHARON AMITY RD STE 201",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282058993",
            "telephone_number": "980-498-2031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AMANAH",
        "first_name": "FUNKE",
        "middle_name": "YENRIN",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-08-07",
        "last_updated": "2020-08-07",
        "certification_date": "2020-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "NC",
            "license": "HC5632",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HC5632",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 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.