Individual
LATEIFAH SHAREE INGRAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
110 E MAIN ST STE 200D, CLINTON, NC 28328-4029
(919) 440-2650
Mailing address
314 PERKINS RD, GOLDSBORO, NC 27530-8053
(919) 440-2650
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
NC
253Z00000X
In Home Supportive Care Agency
HC6967
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
87122057
HOME CARE
NC
Enumeration date
10/19/2022
Last updated
06/26/2023
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