Provider Demographics
NPI:1629796560
Name:NORTH CAROLINA COMMUNITY HOME CARE SERVICES, LLC
Entity Type:Organization
Organization Name:NORTH CAROLINA COMMUNITY HOME CARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:WALTERS-WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-986-1077
Mailing Address - Street 1:414 DERBY WAY
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-2266
Mailing Address - Country:US
Mailing Address - Phone:610-986-1077
Mailing Address - Fax:
Practice Address - Street 1:108 JIGSAW DR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-6125
Practice Address - Country:US
Practice Address - Phone:610-986-1077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-17
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care