Provider Demographics
NPI:1023356938
Name:ST. MARY'S HOME CARE SERVICES, INC.
Entity Type:Organization
Organization Name:ST. MARY'S HOME CARE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELTON
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-441-2486
Mailing Address - Street 1:1977 J N PEASE PL
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-4508
Mailing Address - Country:US
Mailing Address - Phone:704-335-1900
Mailing Address - Fax:
Practice Address - Street 1:1977 J N PEASE PL
Practice Address - Street 2:SUITE 202
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-4508
Practice Address - Country:US
Practice Address - Phone:704-335-1900
Practice Address - Fax:704-335-1888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-28
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3409341Medicaid
NC6601123Medicaid
NC6600781Medicaid
NC6601244Medicaid
NC6601144Medicaid
NC6601186Medicaid