Provider Demographics
NPI:1730314923
Name:HOME SWEET HOME CARE SERVICES, LLC
Entity Type:Organization
Organization Name:HOME SWEET HOME CARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PEBBLE
Authorized Official - Middle Name:DELPHINE
Authorized Official - Last Name:ISLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-824-2587
Mailing Address - Street 1:PO BOX 376
Mailing Address - Street 2:
Mailing Address - City:RAMSEUR
Mailing Address - State:NC
Mailing Address - Zip Code:27316-0376
Mailing Address - Country:US
Mailing Address - Phone:336-824-2587
Mailing Address - Fax:336-824-2587
Practice Address - Street 1:5522 MCQUEEN RD
Practice Address - Street 2:
Practice Address - City:RAMSEUR
Practice Address - State:NC
Practice Address - Zip Code:27316-8772
Practice Address - Country:US
Practice Address - Phone:336-824-2587
Practice Address - Fax:336-824-2587
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOME SWEET HOME CARE SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-05-18
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3636251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3418475Medicaid