Provider Demographics
NPI:1124437371
Name:RELIANCE HEALTH SOURCE LLC
Entity type:Organization
Organization Name:RELIANCE HEALTH SOURCE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:ASAD
Authorized Official - Last Name:BARNETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-844-4684
Mailing Address - Street 1:300 S WESTGATE DR STE A
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-1640
Mailing Address - Country:US
Mailing Address - Phone:336-844-4684
Mailing Address - Fax:
Practice Address - Street 1:300 S WESTGATE DR STE A
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-1640
Practice Address - Country:US
Practice Address - Phone:336-844-4684
Practice Address - Fax:336-740-9342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-12
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No251E00000XAgenciesHome Health
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty