Provider Demographics
NPI:1215294822
Name:CANNON HOME HEALTHCARE
Entity type:Organization
Organization Name:CANNON HOME HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:J
Authorized Official - Last Name:KRYPEL
Authorized Official - Suffix:
Authorized Official - Credentials:MSED
Authorized Official - Phone:704-491-9702
Mailing Address - Street 1:7108 HOLLYHOUSE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-3734
Mailing Address - Country:US
Mailing Address - Phone:704-491-9702
Mailing Address - Fax:704-454-7464
Practice Address - Street 1:7108 HOLLYHOUSE DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-3734
Practice Address - Country:US
Practice Address - Phone:704-491-9702
Practice Address - Fax:704-454-7464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-19
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251E00000X, 251G00000X, 251J00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care