Provider Demographics
NPI:1568083707
Name:MAVILCARE HOME HEALTH AGENCY
Entity Type:Organization
Organization Name:MAVILCARE HOME HEALTH AGENCY
Other - Org Name:MAVILCARE HOME CARE AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AGENCY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:ANAYO
Authorized Official - Last Name:UKWU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-779-4124
Mailing Address - Street 1:10931 E INDEPENDENCE BLVD STE A-3
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-0005
Mailing Address - Country:US
Mailing Address - Phone:704-779-4124
Mailing Address - Fax:
Practice Address - Street 1:10931 E INDEPENDENCE BLVD STE A-3
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-0005
Practice Address - Country:US
Practice Address - Phone:704-779-4124
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-28
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care