Organization
FAIRWAY HOME CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ANTONIO YOUNGER (ADMINISTRATOR)
(336) 724-3390
Entity
Organization
Contact information
Practice address
534 N LIBERTY ST, WINSTON SALEM, NC 27101-2911
(336) 724-3390
(336) 724-3392
Mailing address
534 N LIBERTY ST, WINSTON SALEM, NC 27101-2911
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
HC1727
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3409282
—
NC
05
—
6600620
—
NC
Enumeration date
01/30/2007
Last updated
08/22/2020
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