Healthcare Provider Details

I. General information

NPI: 1366586349
Provider Name (Legal Business Name): HOMEBRIDGE HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 12/13/2023
Certification Date: 12/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 MLK JR RD
MAXTON NC
28364-8958
US

IV. Provider business mailing address

11279 DEEP BRANCH RD
MAXTON NC
28364-8958
US

V. Phone/Fax

Practice location:
  • Phone: 910-844-7049
  • Fax: 910-844-2018
Mailing address:
  • Phone: 910-844-7049
  • Fax: 910-844-2018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code374700000X
TaxonomyTechnician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State

VIII. Authorized Official

Name: SHANNON BURNS
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 910-827-9543