Provider Demographics
NPI:1235546623
Name:WAKE FOREST BAPTIST HEALTH CARE AT HOME, LLC
Entity Type:Organization
Organization Name:WAKE FOREST BAPTIST HEALTH CARE AT HOME, LLC
Other - Org Name:WAKE FOREST BAPATIST HEALTHCARE A HOME, COMMUNITY CARE-WILKES, DISABLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT, LICENSURE
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:COMBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-814-2013
Mailing Address - Street 1:P.O. BOX 4060
Mailing Address - Street 2:ATTN: REGULATORY
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-1157
Mailing Address - Country:US
Mailing Address - Phone:704-662-0416
Mailing Address - Fax:
Practice Address - Street 1:56 BOONE TRAIL
Practice Address - Street 2:
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-3515
Practice Address - Country:US
Practice Address - Phone:336-667-2208
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-17
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 251B00000X, 253Z00000X, 332B00000X, 332U00000X, 385H00000X
NCHC0430251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No251B00000XAgenciesCase Management
No253Z00000XAgenciesIn Home Supportive Care
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332U00000XSuppliersHome Delivered Meals
No385H00000XRespite Care FacilityRespite CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1235546623Medicaid