Provider Demographics
NPI:1477693810
Name:AT HOME PERSONAL CARE SERVICES,INC. OF NORTH CAROLINA
Entity Type:Organization
Organization Name:AT HOME PERSONAL CARE SERVICES,INC. OF NORTH CAROLINA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REGENIA
Authorized Official - Middle Name:LYNELLE
Authorized Official - Last Name:GILLIAM
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:252-321-9300
Mailing Address - Street 1:204 E ARLINGTON BLVD
Mailing Address - Street 2:SUITE M
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-5022
Mailing Address - Country:US
Mailing Address - Phone:252-321-9300
Mailing Address - Fax:252-321-9390
Practice Address - Street 1:204 E ARLINGTON BLVD
Practice Address - Street 2:SUITE M
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5022
Practice Address - Country:US
Practice Address - Phone:252-321-9300
Practice Address - Fax:252-321-9390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3608251E00000X
NCHC2818251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3418065Medicaid
NC6601431Medicaid
NC6006787Medicaid
NC8301812Medicaid