Healthcare Provider Details

I. General information

NPI: 1730358631
Provider Name (Legal Business Name): PAT'S CARE HOME AGENCY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2008
Last Update Date: 02/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 PAGE RD
PINEHURST NC
28374-8751
US

IV. Provider business mailing address

PO BOX 3217
PINEHURST NC
28374-3217
US

V. Phone/Fax

Practice location:
  • Phone: 910-215-5533
  • Fax: 910-215-5523
Mailing address:
  • Phone: 910-215-5533
  • Fax: 910-215-5523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHC2571
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier3408095
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerCAP
# 2
Identifier6601110
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer

VIII. Authorized Official

Name: PATRICIA MCMILLIAN
Title or Position: DIRECTOR
Credential:
Phone: 910-215-5533