Preventive Home Care Agency LLC

Primary specialty

In Home Supportive Care AgencyTaxonomy code 253Z00000X

Legal business name

PREVENTIVE HOME CARE AGENCY LLC

Doing business as

preventive home care

Practice address

105 N Main St Ste 105
Roxboro, NC 27573-5534

Phone

(919) 702-8158

NPI assigned

May 20, 2022

Last updated

Apr 11, 2024By 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

Tiffany Wynetta Johnson

Title

Owner

Phone

(919) 702-8158

Specialties & licenses 1

Addresses

Other names 1

• preventive home care Doing business as

Locations

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

{
    "created_epoch": "1653004800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712793600000",
    "number": "1881332831",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 N MAIN ST STE 105",
            "city": "ROXBORO",
            "state": "NC",
            "postal_code": "275735534",
            "telephone_number": "919-702-8158",
            "fax_number": "336-203-4656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 N MAIN ST STE 105",
            "city": "ROXBORO",
            "state": "NC",
            "postal_code": "275735534",
            "telephone_number": "919-702-8158"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREVENTIVE HOME CARE AGENCY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-20",
        "last_updated": "2024-04-11",
        "certification_date": "2024-04-11",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "TIFFANY",
        "authorized_official_middle_name": "WYNETTA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "919-702-8158"
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "preventive home care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "preventive home care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Adriana Michele Pollak, PA-C
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• In Home Supportive Care Agency in Roxboro, NC
• Providers in Roxboro, NC by specialty
• In Home Supportive Care Agency in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2024; 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.