Organization
TRADITIONAL LIVING HOME CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CASEY VENCILL (OWNER)
(336) 667-4546
Entity
Organization
Contact information
Practice address
101 W MAIN ST, WILKESBORO, NC 28697-2422
(336) 667-4546
(336) 667-2621
Mailing address
101 W MAIN ST, WILKESBORO, NC 28697-2422
(336) 667-4546
(336) 667-2621
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
HC2784
NC
Other
Enumeration date
03/13/2007
Last updated
08/22/2020
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