Executive League Inc

Primary specialty

In Home Supportive Care AgencyTaxonomy code 253Z00000X

Legal business name

EXECUTIVE LEAGUE INC

Doing business as

HomeWell Cares NC218

Practice address

1109 E Wendover Ave Ste a
Greensboro, NC 27405-6778

Phone

(336) 907-6163

NPI assigned

May 23, 2023

Last updated

May 8, 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

Mr. Clarence Mack

Title

President

Phone

(336) 907-6163

Specialties & licenses 1

Addresses

Other names 1

• HomeWell Cares NC218 Doing business as

Locations

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

{
    "created_epoch": "1684800000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715126400000",
    "number": "1962194357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 E WENDOVER AVE STE B",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274056849",
            "telephone_number": "336-907-6163"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1109 E WENDOVER AVE STE A",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274056778",
            "telephone_number": "336-907-6163"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXECUTIVE LEAGUE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-23",
        "last_updated": "2024-05-08",
        "certification_date": "2024-05-08",
        "status": "A",
        "authorized_official_last_name": "MACK",
        "authorized_official_first_name": "CLARENCE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "336-907-6163",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HomeWell Cares NC218",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Providers in Greensboro, 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 May 8, 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.