Provider Demographics
NPI:1104185255
Name:DEDICATED HOME CARE, INC
Entity Type:Organization
Organization Name:DEDICATED HOME CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOHNATHAUN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-479-9856
Mailing Address - Street 1:4173 HEARTHSIDE DR
Mailing Address - Street 2:104
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-8539
Mailing Address - Country:US
Mailing Address - Phone:954-479-9856
Mailing Address - Fax:
Practice Address - Street 1:1910 BIG MILL RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSTON
Practice Address - State:NC
Practice Address - Zip Code:27892-7533
Practice Address - Country:US
Practice Address - Phone:954-479-9856
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-10
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC4391251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health