Organization
PROFESSIONAL CARE HOME HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERESIA MEDLEY (ADMINISTRATOR)
(704) 536-7326
Entity
Organization
Contact information
Practice address
2070 CLOVERDALE AVE, SUITE C, WINSTON-SALEM, NC 28215-5765
(336) 725-0755
Mailing address
2070 CLOVERDALE AVE, SUITE C, WINSTON-SALEM, NC 28215-5765
(336) 725-0755
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000000
DME-WINSTON
NC
Enumeration date
10/16/2008
Last updated
10/16/2008
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