Provider Demographics
NPI:1760530240
Name:OUR HOUSE HOME CARE SERVICE, INC.
Entity Type:Organization
Organization Name:OUR HOUSE HOME CARE SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:WENTIERS
Authorized Official - Middle Name:ANTARIO
Authorized Official - Last Name:LONDON
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:252-634-2211
Mailing Address - Street 1:PO BOX 15123
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28561-5123
Mailing Address - Country:US
Mailing Address - Phone:252-634-2211
Mailing Address - Fax:252-634-2212
Practice Address - Street 1:2807 NEUSE BLVD
Practice Address - Street 2:SUITE 6
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-2815
Practice Address - Country:US
Practice Address - Phone:252-634-2211
Practice Address - Fax:252-634-2212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC 2208251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6601122Medicaid
NC3408044Medicaid
NC6601553Medicaid