Provider Demographics
NPI:1639236193
Name:NORTHEASTERN HOME CARE, INC.
Entity Type:Organization
Organization Name:NORTHEASTERN HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SENTHIA
Authorized Official - Middle Name:B
Authorized Official - Last Name:NEWSOME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-585-0589
Mailing Address - Street 1:9181 US 158 HWY
Mailing Address - Street 2:PO BOX 420
Mailing Address - City:CONWAY
Mailing Address - State:NC
Mailing Address - Zip Code:27820
Mailing Address - Country:US
Mailing Address - Phone:252-585-0589
Mailing Address - Fax:252-585-0572
Practice Address - Street 1:9181 US 158 HWY
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:NC
Practice Address - Zip Code:27820
Practice Address - Country:US
Practice Address - Phone:252-585-0589
Practice Address - Fax:252-585-0572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC2151251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3409411Medicaid
NC6600823Medicaid