Provider Demographics
NPI:1376708859
Name:ADDUS HEALTHCARE (NORTH CAROLINA), INC
Entity Type:Organization
Organization Name:ADDUS HEALTHCARE (NORTH CAROLINA), INC
Other - Org Name:ADDUS HOMECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NATIONAL CONTRACTS
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:KUMARICH
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MS, MBA
Authorized Official - Phone:630-296-3400
Mailing Address - Street 1:2300 WARRENVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1765
Mailing Address - Country:US
Mailing Address - Phone:630-296-3400
Mailing Address - Fax:630-487-2713
Practice Address - Street 1:670 STRATFORD BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28504-9647
Practice Address - Country:US
Practice Address - Phone:252-520-7543
Practice Address - Fax:252-520-1917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-23
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC2137251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCHC2137OtherDHHS LICENSE