Organization
MARY HOME CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TANIKA VONCHEL GREEN BSN (OWNER)
(704) 747-6257
Entity
Organization
Contact information
Practice address
3509 CANYON LIVE OAK CT, GASTONIA, NC 28056-0034
(704) 747-6257
Mailing address
3509 CANYON LIVE OAK CT, GASTONIA, NC 28056-0034
(704) 747-6257
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
253Z00000X
In Home Supportive Care Agency
—
—
311ZA0620X
Adult Care Home Facility
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
385H00000X
Respite Care
—
—
Other
Enumeration date
07/18/2019
Last updated
07/18/2019
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