Provider Demographics
NPI:1790323368
Name:DILACK HOME CARE AND NURSING SERVICES LLC
Entity Type:Organization
Organization Name:DILACK HOME CARE AND NURSING SERVICES LLC
Other - Org Name:DILACK HOMECARE AND NURSING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:EZEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-953-5002
Mailing Address - Street 1:16501D NORTHCROSS DR STE D
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-5081
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16501 NORTHCROSS DR STE D
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-5040
Practice Address - Country:US
Practice Address - Phone:704-953-5002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-13
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty
No163WI0500XNursing Service ProvidersRegistered NurseInfusion TherapyGroup - Multi-Specialty
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite CareGroup - Multi-Specialty