Provider Demographics
NPI:1740557933
Name:BCC HOME CARE SERVICES
Entity Type:Organization
Organization Name:BCC HOME CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:STALLWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-363-0733
Mailing Address - Street 1:9700 RESEARCH DR
Mailing Address - Street 2:SUITE 146
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-8552
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9700 RESEARCH DR
Practice Address - Street 2:SUITE 146
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-8552
Practice Address - Country:US
Practice Address - Phone:704-363-0733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health