Provider Demographics
NPI:1508577701
Name:FOX FALLS HOME CARE LLC
Entity Type:Organization
Organization Name:FOX FALLS HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:VENETIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RICKETTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-837-4023
Mailing Address - Street 1:101 N TRYON ST STE 1126000
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28246-0100
Mailing Address - Country:US
Mailing Address - Phone:215-837-4023
Mailing Address - Fax:
Practice Address - Street 1:101 N TRYON ST STE 1126000
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28246-0100
Practice Address - Country:US
Practice Address - Phone:215-837-4023
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-08
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care