Provider Demographics
NPI:1114069606
Name:MCMILLAN HOME CARE
Entity Type:Organization
Organization Name:MCMILLAN HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMILLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-735-0301
Mailing Address - Street 1:PO BOX 3390
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28359-3390
Mailing Address - Country:US
Mailing Address - Phone:910-735-0301
Mailing Address - Fax:910-735-0334
Practice Address - Street 1:120 EDENS AVE
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-6514
Practice Address - Country:US
Practice Address - Phone:910-735-0301
Practice Address - Fax:910-735-0334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3281251E00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301282Medicaid
NC8301282BMedicaid
NC6601450Medicaid