1477693810 NPI number — AT HOME PERSONAL CARE SERVICES,INC. OF NORTH CAROLINA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477693810 NPI number — AT HOME PERSONAL CARE SERVICES,INC. OF NORTH CAROLINA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AT HOME PERSONAL CARE SERVICES,INC. OF NORTH CAROLINA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477693810
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
204 E ARLINGTON BLVD
Provider Second Line Business Mailing Address:
SUITE M
Provider Business Mailing Address City Name:
GREENVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27858-5022
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-321-9300
Provider Business Mailing Address Fax Number:
252-321-9390

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
204 E ARLINGTON BLVD
Provider Second Line Business Practice Location Address:
SUITE M
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27858-5022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-321-9300
Provider Business Practice Location Address Fax Number:
252-321-9390
Provider Enumeration Date:
02/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GILLIAM
Authorized Official First Name:
REGENIA
Authorized Official Middle Name:
LYNELLE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
252-321-9300

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  HC3608 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , with the licence number: HC2818 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3418065 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6601431 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6006787 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8301812 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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