Healthcare Provider Details

I. General information

NPI: 1881073377
Provider Name (Legal Business Name): NORTH CAROLINA OUTREACH HOME CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2015
Last Update Date: 05/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 GLENN BRIDGE RD STE A
ARDEN NC
28704-3333
US

IV. Provider business mailing address

7 GLENN BRIDGE RD STE A
ARDEN NC
28704-3333
US

V. Phone/Fax

Practice location:
  • Phone: 828-785-1488
  • Fax:
Mailing address:
  • Phone: 828-785-1488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberMHL-011-323
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberMHL-011-323
License Number StateNC

VIII. Authorized Official

Name: SHANNON DURBIN
Title or Position: CHIEF QUALITY OFFICER
Credential:
Phone: 901-410-9058