MEDICARE: HOMESTHAT CARE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730229444
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOMESTHAT CARE, INC.

Provider Business Mailing Address
First Line	:	338 MAPLE AVE
Second Line	:	SUITE 2
City	:	BURLINGTON
State	:	NC
Zip	:	27215-5851
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5403 JAMACA RD
Second Line	:
City	:	CEDAR GROVE
State	:	NC
Zip	:	27231-9462
Country	:	US
Telephone Number	:	919-563-1016
Fax Number	:

Authorized Official
Title or Position	:	TREASURER
Name	:	INA WHITTED
Credential	:
Telephone Number	:	336-227-2420

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	08/22/2020

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