Healthcare Provider Details

I. General information

NPI: 1598883399
Provider Name (Legal Business Name): ST. MARY'S HOME CARE SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1071 PEMBERTON HILL RD SUITE 101
APEX NC
27502-4268
US

IV. Provider business mailing address

1071 PEMBERTON HILL RD SUITE 101
APEX NC
27502-4268
US

V. Phone/Fax

Practice location:
  • Phone: 919-363-1462
  • Fax: 919-367-9474
Mailing address:
  • Phone: 919-363-1462
  • Fax: 919-367-9474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHC2058
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier6600781
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer

VIII. Authorized Official

Name: KATRINA CHERRY
Title or Position: HR DIRECTOR
Credential:
Phone: 919-363-1462