Provider Demographics
NPI:1184976839
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:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELTON
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-274-7282
Mailing Address - Street 1:PO BOX 16104
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27416-0104
Mailing Address - Country:US
Mailing Address - Phone:414-628-0439
Mailing Address - Fax:336-285-5749
Practice Address - Street 1:1910 SEDWICK RD
Practice Address - Street 2:SUITE 500B
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-7807
Practice Address - Country:US
Practice Address - Phone:919-363-1462
Practice Address - Fax:919-367-9474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6600781Medicaid