1619341476 NPI number — AT HOME CARE SERVICES OF NC, INC.

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 1619341476 NPI number — AT HOME CARE SERVICES OF NC, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AT HOME CARE SERVICES OF NC, 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:
1619341476
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/17/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1400 SHARON RD W
Provider Second Line Business Mailing Address:
SUITE C19, BOX 5
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28210-5699
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
980-209-9367
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 SHARON RD W
Provider Second Line Business Practice Location Address:
SUITE C19, BOX 5
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28210-5699
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
980-209-9367
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/17/2015

Additional Information

Authorized Official

Authorized Official Last Name:
GRAY
Authorized Official First Name:
MARVIN
Authorized Official Middle Name:
KENNETH
Authorized Official Title or Position:
OWNER/DIRECTOR
Authorized Official Telephone Number:
980-209-9367

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  HC4755 , 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)





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