Provider Demographics
NPI:1063474740
Name:NATIVE ANGELS HOMECARE AGENCY INC.
Entity Type:Organization
Organization Name:NATIVE ANGELS HOMECARE AGENCY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:BOBBIE
Authorized Official - Middle Name:JACOBS
Authorized Official - Last Name:GHAFFAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-272-6400
Mailing Address - Street 1:201 E. LIVERMORE DRIVE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:NC
Mailing Address - Zip Code:28372-7322
Mailing Address - Country:US
Mailing Address - Phone:910-272-6400
Mailing Address - Fax:910-321-6077
Practice Address - Street 1:201 E. LIVERMORE DRIVE
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:NC
Practice Address - Zip Code:28372-7322
Practice Address - Country:US
Practice Address - Phone:910-272-6400
Practice Address - Fax:910-320-6077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-06
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHOS2861251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3401590Medicaid
341590Medicare Oscar/Certification