Provider Demographics
NPI:1194847806
Name:ST. MARY'S HOME CARE SERVICES, INC
Entity Type:Organization
Organization Name:ST. MARY'S HOME CARE SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HR DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-363-1462
Mailing Address - Street 1:1071 PEMBERTON HILL RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-4268
Mailing Address - Country:US
Mailing Address - Phone:919-363-1462
Mailing Address - Fax:919-367-9474
Practice Address - Street 1:1071 PEMBERTON HILL RD
Practice Address - Street 2:SUITE 101
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-4268
Practice Address - Country:US
Practice Address - Phone:919-363-1462
Practice Address - Fax:919-367-9474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC2058251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3409341Medicaid