Provider Demographics
NPI:1174113468
Name:LOYALTY HOME CARE AGENCY
Entity type:Organization
Organization Name:LOYALTY HOME CARE AGENCY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARICE
Authorized Official - Middle Name:SHAI
Authorized Official - Last Name:BAZEMORE
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:910-354-4068
Mailing Address - Street 1:2225 ANDALUSIAN DR
Mailing Address - Street 2:
Mailing Address - City:HOPE MILLS
Mailing Address - State:NC
Mailing Address - Zip Code:28348-1358
Mailing Address - Country:US
Mailing Address - Phone:910-354-4068
Mailing Address - Fax:
Practice Address - Street 1:2225 ANDALUSIAN DR
Practice Address - Street 2:
Practice Address - City:HOPE MILLS
Practice Address - State:NC
Practice Address - Zip Code:28348-1358
Practice Address - Country:US
Practice Address - Phone:910-354-4068
Practice Address - Fax:910-758-8878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-21
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care