Provider Demographics
NPI:1366628885
Name:INTERCARE HOME HEALTH SERVICE LLC
Entity Type:Organization
Organization Name:INTERCARE HOME HEALTH SERVICE LLC
Other - Org Name:INTERCARE (HOME) HEATH SERVICES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NGOZI
Authorized Official - Middle Name:
Authorized Official - Last Name:NNAJI
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:704-332-9880
Mailing Address - Street 1:311 W 24TH STREET
Mailing Address - Street 2:311 W 24 STREET
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28206
Mailing Address - Country:US
Mailing Address - Phone:704-332-9880
Mailing Address - Fax:704-332-9890
Practice Address - Street 1:311 W 24TH STREET
Practice Address - Street 2:311 W 24TH STREET
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28206
Practice Address - Country:US
Practice Address - Phone:704-332-9880
Practice Address - Fax:704-332-9890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-15
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC208IH0002X251E00000X
251J00000X, 253Z00000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1366628885Medicaid
NC6601558Medicaid