Provider Demographics
NPI:1871651737
Name:HOME LIFE CARE INC
Entity Type:Organization
Organization Name:HOME LIFE CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-332-8265
Mailing Address - Street 1:PO BOX 1106
Mailing Address - Street 2:
Mailing Address - City:AHOSKIE
Mailing Address - State:NC
Mailing Address - Zip Code:27910-1106
Mailing Address - Country:US
Mailing Address - Phone:252-332-8265
Mailing Address - Fax:252-332-1966
Practice Address - Street 1:4054 S MEMORIAL DR
Practice Address - Street 2:SUITE H
Practice Address - City:WINTERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28590-5839
Practice Address - Country:US
Practice Address - Phone:252-355-1118
Practice Address - Fax:252-355-1140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC2800253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6601193Medicaid