1689641144 NPI number — ADORATION HOME HEALTH CARE VIRGINIA LLC

Table of content: (NPI 1689641144)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689641144 NPI number — ADORATION HOME HEALTH CARE VIRGINIA LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADORATION HOME HEALTH CARE VIRGINIA LLC
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:
1689641144
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 18049
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENSBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27419-8049
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-878-8824
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1941 S NC HIGHWAY 119
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEBANE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27302-9738
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-538-1194
Provider Business Practice Location Address Fax Number:
800-311-7783
Provider Enumeration Date:
03/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PEMBERTON
Authorized Official First Name:
MARGARET
Authorized Official Middle Name:
S
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
502-272-3466

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 007CN . This is a "BCBSNC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1027449 . This is a "UHC ACM" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 13151 . This is a "PARTNERS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 3427122 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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