Provider Demographics
NPI:1154451078
Name:MARY B HOME CARE
Entity Type:Organization
Organization Name:MARY B HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KELVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNHILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-972-4080
Mailing Address - Street 1:PO BOX 909
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27802-0909
Mailing Address - Country:US
Mailing Address - Phone:252-972-4080
Mailing Address - Fax:252-972-3380
Practice Address - Street 1:1107 N FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27801-6291
Practice Address - Country:US
Practice Address - Phone:252-972-4080
Practice Address - Fax:252-972-3380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC2820251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6601202Medicaid
NC3408364Medicaid