Provider Demographics
NPI:1114246956
Name:MAYO'S LOVING CARE
Entity Type:Organization
Organization Name:MAYO'S LOVING CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:QP
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:CORMELIUS
Authorized Official - Last Name:MAYO
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:252-281-7717
Mailing Address - Street 1:PO BOX 1705
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27802-1705
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:105 KRISTA LN
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27803-5228
Practice Address - Country:US
Practice Address - Phone:252-973-8593
Practice Address - Fax:252-407-4950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-19
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL 064 115251T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization