Organization
INDEPENDENT LIFE HEALTH SYSTEM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHNATHAUN LEE (OWNER)
(954) 479-9856
Entity
Organization
Contact information
Practice address
1006 UNION RD, A, GASTONIA, NC 28054-0466
(954) 479-9856
Mailing address
1006 UNION RD, A, GASTONIA, NC 28054-0466
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
HC4789
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
HC4789
DMA
NC
Enumeration date
08/20/2015
Last updated
08/20/2015
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