Organization
PROFESSIONAL CARE HOME HEALTH SERVI
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERESIA MEDLEY MSW (ADMINISTRATOR)
(336) 725-0755
Entity
Organization
Contact information
Practice address
2070 CLOVERDALE AVE, SUITE C, WINSTON-SALEM, NC 27103
(336) 725-0755
Mailing address
2070 CLOVERDALE AVE, SUITE C, WINSTON-SALEM, NC 27103
(336) 725-0755
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8700436
—
NC
Enumeration date
01/22/2007
Last updated
06/25/2008
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