Provider Demographics
NPI:1619341476
Name:AT HOME CARE SERVICES OF NC, INC.
Entity Type:Organization
Organization Name:AT HOME CARE SERVICES OF NC, INC.
Other - Org Name:AT HOME CARE SERVICES, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:980-209-9367
Mailing Address - Street 1:1400 SHARON RD W
Mailing Address - Street 2:SUITE C19, BOX 5
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-5699
Mailing Address - Country:US
Mailing Address - Phone:980-209-9367
Mailing Address - Fax:
Practice Address - Street 1:1400 SHARON RD W
Practice Address - Street 2:SUITE C19, BOX 5
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-5699
Practice Address - Country:US
Practice Address - Phone:980-209-9367
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-17
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC4755251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health