Provider Demographics
NPI:1346399870
Name:NORTH CAROLINA OUTREACH HOME CARE LLC
Entity Type:Organization
Organization Name:NORTH CAROLINA OUTREACH HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:DURBIN
Authorized Official - Suffix:
Authorized Official - Credentials:EDD,
Authorized Official - Phone:901-383-9193
Mailing Address - Street 1:1155 N MAIN ST STE 16
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:NC
Mailing Address - Zip Code:28752-6541
Mailing Address - Country:US
Mailing Address - Phone:828-652-2112
Mailing Address - Fax:828-559-3729
Practice Address - Street 1:1155 N MAIN ST STE 16
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:NC
Practice Address - Zip Code:28752-6541
Practice Address - Country:US
Practice Address - Phone:828-652-2112
Practice Address - Fax:828-559-3729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC 2304251C00000X, 251E00000X
251S00000X
NCHC2304253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3409530Medicaid
NC6600912Medicaid
NC6600912Medicaid