Healthcare Provider Details

I. General information

NPI: 1609996446
Provider Name (Legal Business Name): ETCARE HOME QUALITY MANAGEMENT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 06/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 WANNISH AVE
LAKE WACCAMAW NC
28450
US

IV. Provider business mailing address

PO BOX 1179
PEMBROKE NC
28372-1179
US

V. Phone/Fax

Practice location:
  • Phone: 910-646-3153
  • Fax:
Mailing address:
  • Phone: 910-521-5550
  • Fax: 910-521-3335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberHAL-024-009
License Number StateNC

VIII. Authorized Official

Name: EDITH W. BIGLER
Title or Position: MANAGER
Credential:
Phone: 910-521-5550