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General NPI Number Information
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NPI Number | 1205825759
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Entity Type | Organization
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Legal Business Name | AVID HEALTH AT HOME NORTH CAROLINA
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Dates
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Enumeration Date | 10/18/2005
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Last Update Date | 12/31/2024
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Provider Practice Location Address
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Address Line | 1508 MILITARY CUTOFF RD STE 304
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City | WILMINGTON
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State | NC
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Zip | 28403-5730
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Country | US
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Telephone | 910-452-1555
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Fax | 910-343-0352
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Provider Business Mailing Address
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Address Line | 1508 MILITARY CUTOFF RD STE 304
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City | WILMINGTON
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State | NC
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Zip | 28403-5730
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Country | US
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Telephone | 910-343-9996
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Fax | 910-343-0352
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Authorized Official
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Title or Position | CEO
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Name | JENNIFER LENTZ
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Credential |
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Telephone | 516-458-6769
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | HC1231
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | HC0088
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | HC0088
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License Number State | NC
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