MEDICARE: TAR HEEL HEALTH CARE SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	0078A	OTHER	G2
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558391391
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAR HEEL HEALTH CARE SERVICES, LLC

Provider Business Mailing Address
First Line	:	6330 SPRINT PKWY STE 300
Second Line	:
City	:	OVERLAND PARK
State	:	KS
Zip	:	66211-1157
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2615 HOSPITAL RD STE 100
Second Line	:
City	:	GOLDSBORO
State	:	NC
Zip	:	27534-9424
Country	:	US
Telephone Number	:	919-731-7254
Fax Number	:	919-751-3433

Authorized Official
Title or Position	:	AUTHORIZED SIGNATORY
Name	:	JOHN W NICHOLS
Credential	:
Telephone Number	:	913-814-2077

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	04/06/2023

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