Provider Demographics
NPI:1871688150
Name:M&B LOVING HOME CARE
Entity Type:Organization
Organization Name:M&B LOVING HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLEPROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:BULLUCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-907-1759
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:NC
Mailing Address - Zip Code:27844-0936
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3793 SHEARIN RD
Practice Address - Street 2:
Practice Address - City:WHITAKERS
Practice Address - State:NC
Practice Address - Zip Code:27891-9489
Practice Address - Country:US
Practice Address - Phone:252-907-1759
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3055251B00000X, 251E00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3418029Medicaid
NC6601312Medicaid