Provider Demographics
NPI:1053460741
Name:ESSENTIAL LIVING HOME CARE SERVICES LLC
Entity Type:Organization
Organization Name:ESSENTIAL LIVING HOME CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SYLVIA
Authorized Official - Middle Name:CARAWAY
Authorized Official - Last Name:CAPEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-994-2797
Mailing Address - Street 1:2484 US HIGHWAY 74 EAST
Mailing Address - Street 2:
Mailing Address - City:WADESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28170
Mailing Address - Country:US
Mailing Address - Phone:704-994-2797
Mailing Address - Fax:800-948-0651
Practice Address - Street 1:2484 US HIGWAY 74 EAST
Practice Address - Street 2:
Practice Address - City:WADESBORO
Practice Address - State:NC
Practice Address - Zip Code:28170
Practice Address - Country:US
Practice Address - Phone:704-994-2797
Practice Address - Fax:800-948-0651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6601568Medicaid