1013150671 NPI number — ST. VINCENT HOME CARE SERVICES, INC

Table of content: (NPI 1013150671)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013150671 NPI number — ST. VINCENT HOME CARE SERVICES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST. VINCENT HOME CARE SERVICES, INC
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:
6
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:
1013150671
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/13/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P O BOX 803
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GASTONIA
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28052-0803
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-853-2111
Provider Business Mailing Address Fax Number:
704-853-2114

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 E FRANKLIN BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GASTONIA
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28054-7150
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-853-2111
Provider Business Practice Location Address Fax Number:
704-853-2114
Provider Enumeration Date:
04/13/2009

Additional Information

Authorized Official

Authorized Official Last Name:
KENNON
Authorized Official First Name:
ROSLIN
Authorized Official Middle Name:
GARNER
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
704-853-2111

Provider Taxonomy Codes

  • Taxonomy code: 3747P1801X , with the licence number:  HC3801 , 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: HC3801 . This is a "NC HHS DIVISION OF HEALTH SERVICES REGULATION" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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