Provider Demographics
NPI:1679067854
Name:FAYETTEVILLE NC HOMECARE LLC
Entity Type:Organization
Organization Name:FAYETTEVILLE NC HOMECARE LLC
Other - Org Name:VISITING ANGELS- FAYETTEVILLE, NC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:GORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-500-6955
Mailing Address - Street 1:2929 BREEZEWOOD AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-5357
Mailing Address - Country:US
Mailing Address - Phone:910-500-6955
Mailing Address - Fax:910-500-6956
Practice Address - Street 1:2929 BREEZEWOOD AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-5357
Practice Address - Country:US
Practice Address - Phone:910-500-6955
Practice Address - Fax:910-500-6956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-20
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC4695253Z00000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care