Organization
AGELESS HEART HEALTHCARE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHNATHAUN LEE (PRESIDENT)
(910) 230-0555
Entity
Organization
Contact information
Practice address
708 S 13TH ST, ERWIN, NC 28339-2634
(910) 292-0173
(910) 292-0174
Mailing address
708 S 13TH ST, ERWIN, NC 28339-2634
(910) 230-0555
(910) 230-0550
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
HC2965
NC
3747P1801X
Personal Care Attendant
HC2965
NC
Other
Enumeration date
08/13/2010
Last updated
06/14/2013
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