Provider Demographics
NPI:1003425109
Name:FOUR OAKS HOME CARE SERVICES LLC- PART 1
Entity Type:Organization
Organization Name:FOUR OAKS HOME CARE SERVICES LLC- PART 1
Other - Org Name:FOUR OAKS HOME CARE SERVICES LLS -PART 1
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:UCHENNA
Authorized Official - Middle Name:JUNIOR
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-491-8231
Mailing Address - Street 1:611 SUMMIT AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-7746
Mailing Address - Country:US
Mailing Address - Phone:336-491-8231
Mailing Address - Fax:
Practice Address - Street 1:301 W J J DR STE C
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27406-4445
Practice Address - Country:US
Practice Address - Phone:336-491-8231
Practice Address - Fax:877-895-1090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-24
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1003425109Medicaid