Provider Demographics
NPI:1811040397
Name:ATLANTIC COAST HOME CARE
Entity Type:Organization
Organization Name:ATLANTIC COAST HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLTON
Authorized Official - Middle Name:
Authorized Official - Last Name:THORNTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-236-3988
Mailing Address - Street 1:8301 UNIVERSITY EXECUTIVE PARK DRIVE
Mailing Address - Street 2:SUITE 170
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-3593
Mailing Address - Country:US
Mailing Address - Phone:704-549-5800
Mailing Address - Fax:704-549-5888
Practice Address - Street 1:8301 UNIVERSITY EXEC PARK DR
Practice Address - Street 2:SUITE 170
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-3593
Practice Address - Country:US
Practice Address - Phone:704-549-5800
Practice Address - Fax:704-549-5888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6601580251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6601580Medicaid