Provider Demographics
NPI:1366777807
Name:POTTERS HOUSE HOME HEALTHCARE
Entity type:Organization
Organization Name:POTTERS HOUSE HOME HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MELRENA
Authorized Official - Middle Name:D
Authorized Official - Last Name:MCINNIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-890-6114
Mailing Address - Street 1:4100-B THE PLAZA
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205
Mailing Address - Country:US
Mailing Address - Phone:704-890-6114
Mailing Address - Fax:
Practice Address - Street 1:4100-B THE PLAZA
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205
Practice Address - Country:US
Practice Address - Phone:704-890-6114
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-15
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health