Healthcare Provider Details

I. General information

NPI: 1871688150
Provider Name (Legal Business Name): M&B LOVING HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3793 SHEARIN RD
WHITAKERS NC
27891-9489
US

IV. Provider business mailing address

PO BOX 936
HOLLISTER NC
27844-0936
US

V. Phone/Fax

Practice location:
  • Phone: 252-907-1759
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHC3055
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License NumberHC3055
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberHC3055
License Number StateNC

VIII. Authorized Official

Name: MARY BULLUCK
Title or Position: SOLEPROPRIETOR
Credential:
Phone: 252-907-1759