Provider Demographics
NPI:1710030432
Name:DETERMINED HOME CARE AGENCY LLC
Entity Type:Organization
Organization Name:DETERMINED HOME CARE AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-281-4838
Mailing Address - Street 1:301 S CHURCH ST
Mailing Address - Street 2:SUITE 144
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-5755
Mailing Address - Country:US
Mailing Address - Phone:252-454-0404
Mailing Address - Fax:252-454-0405
Practice Address - Street 1:301 S CHURCH ST
Practice Address - Street 2:SUITE 144
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-5755
Practice Address - Country:US
Practice Address - Phone:252-454-0404
Practice Address - Fax:252-454-0405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3103251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408698Medicaid
NC6601330Medicaid