Provider Demographics
NPI:1710579016
Name:MANAGED CARE DIVERSIFIED HOME CARE SERVICES
Entity Type:Organization
Organization Name:MANAGED CARE DIVERSIFIED HOME CARE SERVICES
Other - Org Name:MANAGED CARE DIVERSIFIED HOME CARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:CORBETT
Authorized Official - Last Name:DAWES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-641-6885
Mailing Address - Street 1:PO BOX 602
Mailing Address - Street 2:
Mailing Address - City:TARBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27886-0602
Mailing Address - Country:US
Mailing Address - Phone:252-641-6885
Mailing Address - Fax:252-641-6889
Practice Address - Street 1:1600 WESTERN BLVD
Practice Address - Street 2:SUITE #31
Practice Address - City:TARBORO
Practice Address - State:NC
Practice Address - Zip Code:27886-2788
Practice Address - Country:US
Practice Address - Phone:252-641-6885
Practice Address - Fax:252-641-5889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-08
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health