Provider Demographics
NPI:1700620747
Name:HOME ASSISTED LIVING OPPORTUNITIES LLC
Entity type:Organization
Organization Name:HOME ASSISTED LIVING OPPORTUNITIES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHAMICA
Authorized Official - Middle Name:LONETTE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-510-9838
Mailing Address - Street 1:615 SAINT GEORGE SQUARE CT STE 361
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-1368
Mailing Address - Country:US
Mailing Address - Phone:573-510-9838
Mailing Address - Fax:256-325-5026
Practice Address - Street 1:615 SAINT GEORGE SQUARE CT STE 361
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1368
Practice Address - Country:US
Practice Address - Phone:573-510-9838
Practice Address - Fax:256-325-5026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-24
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care