Provider Demographics
NPI:1013150671
Name:ST. VINCENT HOME CARE SERVICES, INC
Entity Type:Organization
Organization Name:ST. VINCENT HOME CARE SERVICES, INC
Other - Org Name:ST. VINCENT HOME CARE AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ROSLIN
Authorized Official - Middle Name:GARNER
Authorized Official - Last Name:KENNON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-853-2111
Mailing Address - Street 1:P O BOX 803
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28052-0803
Mailing Address - Country:US
Mailing Address - Phone:704-853-2111
Mailing Address - Fax:704-853-2114
Practice Address - Street 1:601 E FRANKLIN BLVD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-7150
Practice Address - Country:US
Practice Address - Phone:704-853-2111
Practice Address - Fax:704-853-2114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-13
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC38013747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCHC3801OtherNC HHS DIVISION OF HEALTH SERVICES REGULATION