Provider Demographics
NPI:1205825759
Name:AVID HEALTH AT HOME NORTH CAROLINA
Entity type:Organization
Organization Name:AVID HEALTH AT HOME NORTH CAROLINA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:LENTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-458-6769
Mailing Address - Street 1:1508 MILITARY CUTOFF RD STE 304
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-5730
Mailing Address - Country:US
Mailing Address - Phone:910-343-9996
Mailing Address - Fax:910-343-0352
Practice Address - Street 1:1508 MILITARY CUTOFF RD STE 304
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-5730
Practice Address - Country:US
Practice Address - Phone:910-452-1555
Practice Address - Fax:910-343-0352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-18
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC1231251E00000X
NCHC0088251J00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6600144Medicaid
NC7100096Medicaid
NC6601424Medicaid
NC6601426Medicaid
NC6601425Medicaid
NC7100103Medicaid
NC0077TOtherBCBS PDN
NC7100524Medicaid
NC3408345Medicaid
NC7100525Medicaid