Provider Demographics
NPI:1104839935
Name:AMERICARE EHALTH
Entity Type:Organization
Organization Name:AMERICARE EHALTH
Other - Org Name:MARSVILLE HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:IYORE
Authorized Official - Middle Name:IRENE
Authorized Official - Last Name:OJOMO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-624-9200
Mailing Address - Street 1:7204 E MARSHVILLE BLVD
Mailing Address - Street 2:
Mailing Address - City:MARSHVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28103-1191
Mailing Address - Country:US
Mailing Address - Phone:704-624-9200
Mailing Address - Fax:704-624-9201
Practice Address - Street 1:7204 E MARSHVILLE BLVD
Practice Address - Street 2:
Practice Address - City:MARSHVILLE
Practice Address - State:NC
Practice Address - Zip Code:28103-1191
Practice Address - Country:US
Practice Address - Phone:704-624-9200
Practice Address - Fax:704-624-9201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0200GOtherBLUECROSS BLUESHIELD ID
NC790200GMedicaid
NC0200GOtherBLUECROSS BLUESHIELD ID