Healthcare Provider Details

I. General information

NPI: 1023344900
Provider Name (Legal Business Name): HOME CARE ANGEL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2009
Last Update Date: 10/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1552 COLLEGE WAY
NEW BERN NC
28562-5139
US

IV. Provider business mailing address

1552 COLLEGE WAY
NEW BERN NC
28562-5139
US

V. Phone/Fax

Practice location:
  • Phone: 919-741-8476
  • Fax:
Mailing address:
  • Phone: 919-741-8476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: GERAMY M MARKS
Title or Position: FOUNDING MEMBER
Credential: MPT
Phone: 919-741-8476