Provider Demographics
NPI:1407393598
Name:DEDICATED HOME SERVICES INC
Entity Type:Organization
Organization Name:DEDICATED HOME SERVICES INC
Other - Org Name:INTERIM HEALTHCARE OF THE CAROLINAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BOGAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-658-0555
Mailing Address - Street 1:631 BRAWLEY SCHOOL ROAD
Mailing Address - Street 2:STE 300 PMB 227
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-8545
Mailing Address - Country:US
Mailing Address - Phone:704-658-0555
Mailing Address - Fax:866-238-8409
Practice Address - Street 1:148 CEDAR POINTE DR STE 101A
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-9404
Practice Address - Country:US
Practice Address - Phone:704-658-0555
Practice Address - Fax:866-238-8409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-26
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNP4399251J00000X
253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251J00000XAgenciesNursing Care