Provider Demographics
NPI:1871839332
Name:BARBARA KING HOME AGENCY INC
Entity Type:Organization
Organization Name:BARBARA KING HOME AGENCY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LOCKSLEY
Authorized Official - Middle Name:LISA
Authorized Official - Last Name:MCFADDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-988-3541
Mailing Address - Street 1:2932 BREEZEWOOD AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-5455
Mailing Address - Country:US
Mailing Address - Phone:910-354-5459
Mailing Address - Fax:910-304-6787
Practice Address - Street 1:2932 BREEZEWOOD AVE STE 103
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-5455
Practice Address - Country:US
Practice Address - Phone:910-354-5459
Practice Address - Fax:910-304-6787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-02
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC4613103TC0700X, 171W00000X, 225XM0800X, 251E00000X, 253J00000X, 253Z00000X, 282NR1301X, 302R00000X, 390200000X
251G00000X, 385HR2055X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive Care
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No171W00000XOther Service ProvidersContractorGroup - Single Specialty
No225XM0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistMental HealthGroup - Single Specialty
No251E00000XAgenciesHome HealthGroup - Single Specialty
No251G00000XAgenciesHospice Care, Community Based
No253J00000XAgenciesFoster Care Agency
No282NR1301XHospitalsGeneral Acute Care HospitalRuralGroup - Single Specialty
No302R00000XManaged Care OrganizationsHealth Maintenance Organization
No385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, ChildGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC460910901OtherCAP DA
NC460910901Medicaid
NC460910901OtherCAP C
NC460910901OtherNORTH CAROLINA DIVISION OF AGING AND ADULT SERVICES
NC460910901OtherMENTAL HEALTH
NC460910901OtherMEDICARE
NC460910901OtherVA
NC460910901OtherBLUE CROSS BLUE SHIELD N.C.
NC460910901OtherCAP CHOICE
NC460910901OtherCAP PROGRAMS
NC460910901OtherPRIVATE PAY
NC460910901OtherMEDICARD