Provider Demographics
NPI:1821120239
Name:NORTHCARE HEALTH SERVICES
Entity Type:Organization
Organization Name:NORTHCARE HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:DEIMANTAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-757-0029
Mailing Address - Street 1:640 MEDICAL DR
Mailing Address - Street 2:SUITE H
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-7502
Mailing Address - Country:US
Mailing Address - Phone:252-757-0029
Mailing Address - Fax:252-757-0034
Practice Address - Street 1:640 MEDICAL DR
Practice Address - Street 2:SUITE H
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-7502
Practice Address - Country:US
Practice Address - Phone:252-757-0029
Practice Address - Fax:252-757-0034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC 0072251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408586Medicaid