Provider Demographics
NPI:1114169398
Name:ST. LUKE HOME CARE SERVICES
Entity Type:Organization
Organization Name:ST. LUKE HOME CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VERA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:252-823-7175
Mailing Address - Street 1:101 NEVILLE ST
Mailing Address - Street 2:POB 13
Mailing Address - City:PRINCEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27886-5327
Mailing Address - Country:US
Mailing Address - Phone:252-823-7176
Mailing Address - Fax:252-823-6244
Practice Address - Street 1:101 NEVILLE ST
Practice Address - Street 2:POB 13
Practice Address - City:PRINCEVILLE
Practice Address - State:NC
Practice Address - Zip Code:27886-5327
Practice Address - Country:US
Practice Address - Phone:252-823-7176
Practice Address - Fax:252-823-6244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-02
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3500251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3418231Medicaid
NC6601587Medicaid