Provider Demographics
NPI:1942327150
Name:ENHACING SPIRITS HOMECARE AGENCY,INC
Entity Type:Organization
Organization Name:ENHACING SPIRITS HOMECARE AGENCY,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:910-671-8128
Mailing Address - Street 1:801 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-5413
Mailing Address - Country:US
Mailing Address - Phone:910-671-8128
Mailing Address - Fax:910-671-8130
Practice Address - Street 1:801 W 5TH ST
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-5413
Practice Address - Country:US
Practice Address - Phone:910-671-8128
Practice Address - Fax:910-671-8130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3521251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6601625Medicaid