Provider Demographics
NPI:1689731911
Name:LILY CARE INC
Entity Type:Organization
Organization Name:LILY CARE INC
Other - Org Name:LILY CARE INC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TICE
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:RANDOLPH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-659-8879
Mailing Address - Street 1:50 STATE STREET
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:NC
Mailing Address - Zip Code:28752-4548
Mailing Address - Country:US
Mailing Address - Phone:828-659-8879
Mailing Address - Fax:828-659-8879
Practice Address - Street 1:50 STATE ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:NC
Practice Address - Zip Code:28752-4021
Practice Address - Country:US
Practice Address - Phone:828-659-8879
Practice Address - Fax:828-659-8879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC2338251E00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408122Medicaid
NC6600926Medicaid