Provider Demographics
NPI:1265728869
Name:CENTRAL CAROLINA HOME HEALTHCARE
Entity type:Organization
Organization Name:CENTRAL CAROLINA HOME HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO,CNO
Authorized Official - Prefix:MRS
Authorized Official - First Name:URSULA
Authorized Official - Middle Name:TOMIKA
Authorized Official - Last Name:WHITE,
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:910-920-3921
Mailing Address - Street 1:PO BOX 11065
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-2799
Mailing Address - Country:US
Mailing Address - Phone:910-920-3921
Mailing Address - Fax:800-486-4319
Practice Address - Street 1:111 LAMON ST
Practice Address - Street 2:SUITE 119
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-4901
Practice Address - Country:US
Practice Address - Phone:910-920-3921
Practice Address - Fax:800-486-4319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-22
Last Update Date:2013-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC4424251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3419172Medicaid
NC6602287Medicaid