MEDICARE: ST. MARY'S HOME CARE SERVICES, 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	251E00000X	Home Health Agency	HC2369	NC

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	:	1932236437
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. MARY'S HOME CARE SERVICES, INC

Provider Business Mailing Address
First Line	:	1091 PEMBERTON HILL RD STE 101
Second Line	:
City	:	APEX
State	:	NC
Zip	:	27502-4269
Country	:	US
Telephone Number	:	919-363-1462
Fax Number	:

Provider Business Practice Location Address
First Line	:	1977 J N PEASE PL STE 202
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28262-4527
Country	:	US
Telephone Number	:	704-335-1900
Fax Number	:	704-335-1888

Authorized Official
Title or Position	:	HR DIRECTOR
Name	:	KATRINA CHERRY
Credential	:
Telephone Number	:	919-363-1462

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	08/22/2020

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