Healthcare Provider Details

I. General information

NPI: 1689731911
Provider Name (Legal Business Name): LILY CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 11/21/2023
Certification Date: 11/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 STATE ST
MARION NC
28752-4021
US

IV. Provider business mailing address

50 STATE STREET
MARION NC
28752-4548
US

V. Phone/Fax

Practice location:
  • Phone: 828-659-8879
  • Fax: 828-659-8879
Mailing address:
  • Phone: 828-659-8879
  • Fax: 828-659-8879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHC2338
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberHC2338
License Number StateNC

VIII. Authorized Official

Name: MR. TICE JAMES RANDOLPH
Title or Position: OWNER
Credential:
Phone: 828-659-8879