Provider Demographics
NPI:1275249880
Name:ASECONDHOMECARE
Entity Type:Organization
Organization Name:ASECONDHOMECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LATINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:COSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-758-4078
Mailing Address - Street 1:311 NEW BERN AVE UNIT 24963
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27611-0120
Mailing Address - Country:US
Mailing Address - Phone:919-758-4078
Mailing Address - Fax:
Practice Address - Street 1:845 SKINNER DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-8011
Practice Address - Country:US
Practice Address - Phone:919-758-4078
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health