Provider Demographics
NPI:1134547771
Name:HAIRSTON ELDERCARE SERVICES INC
Entity type:Organization
Organization Name:HAIRSTON ELDERCARE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CAMERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAIRSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-895-7991
Mailing Address - Street 1:PO BOX 2784
Mailing Address - Street 2:
Mailing Address - City:ROCKINGHAM
Mailing Address - State:NC
Mailing Address - Zip Code:28380-2784
Mailing Address - Country:US
Mailing Address - Phone:910-895-7991
Mailing Address - Fax:910-895-7993
Practice Address - Street 1:325 S LONG DR
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:NC
Practice Address - Zip Code:28379-3991
Practice Address - Country:US
Practice Address - Phone:910-895-7991
Practice Address - Fax:910-895-7993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-01
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251C00000X, 251E00000X, 251S00000X, 253Z00000X, 251B00000X, 261QD1600X, 261QH0100X, 261Q00000X
NC7796101YP2500X
NCP0086681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No251C00000XAgenciesDay Training, Developmentally Disabled ServicesGroup - Single Specialty
No251E00000XAgenciesHome HealthGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No251B00000XAgenciesCase Management
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service