Provider Demographics
NPI:1922353523
Name:SANDHILLS HOME CARE, LLC
Entity Type:Organization
Organization Name:SANDHILLS HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-690-0582
Mailing Address - Street 1:PO BOX 1447
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:NC
Mailing Address - Zip Code:28327-1447
Mailing Address - Country:US
Mailing Address - Phone:910-690-0582
Mailing Address - Fax:910-521-8767
Practice Address - Street 1:401 E 3RD ST
Practice Address - Street 2:UNIT 3C
Practice Address - City:PEMBROKE
Practice Address - State:NC
Practice Address - Zip Code:28372-8889
Practice Address - Country:US
Practice Address - Phone:910-521-1198
Practice Address - Fax:910-521-8767
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SANDHILL'S HOME CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-07-19
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC4426251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3419126Medicaid