Provider Demographics
NPI:1881674083
Name:MECKLENBURG HOME HEALTH, INC.
Entity Type:Organization
Organization Name:MECKLENBURG HOME HEALTH, INC.
Other - Org Name:HOME HEALTH PROFESSIONALS GASTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NICK
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLEDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-679-8852
Mailing Address - Street 1:2550 COURT DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-2152
Mailing Address - Country:US
Mailing Address - Phone:704-864-1131
Mailing Address - Fax:704-867-6852
Practice Address - Street 1:2550 COURT DR
Practice Address - Street 2:SUITE 103
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-2152
Practice Address - Country:US
Practice Address - Phone:704-864-1131
Practice Address - Fax:704-867-6852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC0356251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3407326Medicaid
NC347326Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER