Provider Demographics
NPI:1255516290
Name:DELIVERANCE HOME CARE, LLC
Entity type:Organization
Organization Name:DELIVERANCE HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:J
Authorized Official - Last Name:CROSBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-279-1144
Mailing Address - Street 1:2804 RANDLEMAN RD
Mailing Address - Street 2:SUITE Q
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27406-5263
Mailing Address - Country:US
Mailing Address - Phone:336-279-1144
Mailing Address - Fax:336-378-1018
Practice Address - Street 1:2804 RANDLEMAN RD
Practice Address - Street 2:SUITE Q
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27406-5263
Practice Address - Country:US
Practice Address - Phone:336-279-1144
Practice Address - Fax:336-378-1018
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DELIVERANCE HOME CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-09
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3418364251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3418364Medicaid