Provider Demographics
NPI:1629198536
Name:ST. MARY'S HOME CARE, INC.
Entity Type:Organization
Organization Name:ST. MARY'S HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:RHODES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-446-6685
Mailing Address - Street 1:1111 WESYLAN BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804
Mailing Address - Country:US
Mailing Address - Phone:252-446-6685
Mailing Address - Fax:252-446-6695
Practice Address - Street 1:1111 S WESLEYAN BLVD
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27803-3114
Practice Address - Country:US
Practice Address - Phone:252-446-6685
Practice Address - Fax:252-446-6695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC2572251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6601144Medicaid