Provider Demographics
NPI:1255615746
Name:IN HOME HEALTHCARE PROFESSIONALS
Entity type:Organization
Organization Name:IN HOME HEALTHCARE PROFESSIONALS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:GAIUS
Authorized Official - Last Name:REDIC
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:704-756-7251
Mailing Address - Street 1:1811 SARDIS RD N
Mailing Address - Street 2:220
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28270-1426
Mailing Address - Country:US
Mailing Address - Phone:704-847-2898
Mailing Address - Fax:
Practice Address - Street 1:1811 SARDIS RD N
Practice Address - Street 2:220
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28270-1426
Practice Address - Country:US
Practice Address - Phone:704-847-2898
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-04
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC4455253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care