Provider Demographics
NPI:1710142757
Name:COMPANION HOME CARE
Entity Type:Organization
Organization Name:COMPANION HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:SMITH
Authorized Official - Last Name:F
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-608-3511
Mailing Address - Street 1:PO BOX 753
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28359-0753
Mailing Address - Country:US
Mailing Address - Phone:910-608-3511
Mailing Address - Fax:910-608-3530
Practice Address - Street 1:3317 NC HIGHWAY 211 W
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28360-3570
Practice Address - Country:US
Practice Address - Phone:910-608-6511
Practice Address - Fax:910-608-3530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-18
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-078-162251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8302008GMedicaid