Provider Demographics
NPI:1366727265
Name:WITH LOVING CARE HOME HEALTH CARE AGENCY
Entity type:Organization
Organization Name:WITH LOVING CARE HOME HEALTH CARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MONIQUE
Authorized Official - Middle Name:LADOSCA
Authorized Official - Last Name:MOCK
Authorized Official - Suffix:
Authorized Official - Credentials:NURSING ASSISTANT
Authorized Official - Phone:1336-793-6007
Mailing Address - Street 1:1065 SWAIM WOODS LN
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27107-5461
Mailing Address - Country:US
Mailing Address - Phone:336-793-6007
Mailing Address - Fax:
Practice Address - Street 1:1065 SWAIM WOODS LN
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27107-5461
Practice Address - Country:US
Practice Address - Phone:336-793-6007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-12
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Single Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty