Provider Demographics
NPI:1134249584
Name:ST. MARY'S HOME CARE SERVICES, INC.
Entity type:Organization
Organization Name:ST. MARY'S HOME CARE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:LATAYA
Authorized Official - Middle Name:LASHA
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-762-5557
Mailing Address - Street 1:2214 WRIGHTSVILLE AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-2577
Mailing Address - Country:US
Mailing Address - Phone:910-762-5557
Mailing Address - Fax:910-762-5553
Practice Address - Street 1:2214 WRIGHTSVILLE AVE
Practice Address - Street 2:SUITE E
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-2577
Practice Address - Country:US
Practice Address - Phone:910-762-5557
Practice Address - Fax:910-762-5553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC2369251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6601186Medicaid