Provider Demographics
NPI:1528296555
Name:HIS HOME CARE AGENCY
Entity type:Organization
Organization Name:HIS HOME CARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GLENDA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:HANSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:980-226-5041
Mailing Address - Street 1:2020 BEATTIES FORD RD STE E
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-4573
Mailing Address - Country:US
Mailing Address - Phone:980-229-8054
Mailing Address - Fax:980-226-5158
Practice Address - Street 1:862 SOUTHWEST DR
Practice Address - Street 2:
Practice Address - City:DAVIDSON
Practice Address - State:NC
Practice Address - Zip Code:28036-7910
Practice Address - Country:US
Practice Address - Phone:980-229-5041
Practice Address - Fax:980-226-5158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-29
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health