Healthcare Provider Details

I. General information

NPI: 1366369746
Provider Name (Legal Business Name): LUMBEE ANGELS 575 HOME CARE AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 UNION CHAPEL RD STE B
PEMBROKE NC
28372-7142
US

IV. Provider business mailing address

621 UNION CHAPEL RD STE B
PEMBROKE NC
28372-7142
US

V. Phone/Fax

Practice location:
  • Phone: 910-775-9255
  • Fax: 910-775-9257
Mailing address:
  • Phone: 910-775-9255
  • Fax: 910-775-9257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: CARITA JACOBS
Title or Position: CEO AND FOUNDER
Credential:
Phone: 910-775-9255