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Active
Organization subpart
No

Provider details

NPI number
Authorized official
SHANTA LENESE HARRELL (OWNER/ADMINISTRATOR)
(252) 642-9993
Entity
Organization

Contact information

Practice address
106 HOLLOMAN AVE E, AHOSKIE, NC 27910-2307
(252) 642-9993
Mailing address
1219 CATHERINE ST N, AHOSKIE, NC 27910-2303
(252) 642-9993

Taxonomy

Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
FCL-046-025
NC

Other

Enumeration date
04/04/2013
Last updated
04/04/2013
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