=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841997442
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HE CARES HEALTHCARE SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/14/2023
-----------------------------------------------------
Last Update Date | 02/14/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 312 W WALL ST
-----------------------------------------------------
City | LILESVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28091-5070
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-451-1849
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 312 W WALL ST
-----------------------------------------------------
City | LILESVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28091-5070
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | LARRY MATHIS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 202-451-1849
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------