Provider Demographics
NPI:1992199004
Name:MOORESVILLE HOME CARE
Entity Type:Organization
Organization Name:MOORESVILLE HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:CARA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH BAINES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-978-8835
Mailing Address - Street 1:179 GASOLINE ALLEY
Mailing Address - Street 2:SUITE 210
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117
Mailing Address - Country:US
Mailing Address - Phone:704-978-8835
Mailing Address - Fax:
Practice Address - Street 1:179 GASOLINE ALY
Practice Address - Street 2:SUITE 210
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-6513
Practice Address - Country:US
Practice Address - Phone:704-978-8835
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-26
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC253Z00000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
No253Z00000XAgenciesIn Home Supportive Care