Provider Demographics
NPI:1295720589
Name:SLOOP CAP-AVERY HOME CARE SERVICES
Entity type:Organization
Organization Name:SLOOP CAP-AVERY HOME CARE SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:G
Authorized Official - Last Name:HOLLAND
Authorized Official - Suffix:
Authorized Official - Credentials:BS,CMC
Authorized Official - Phone:828-733-1062
Mailing Address - Street 1:PO BOX 489
Mailing Address - Street 2:
Mailing Address - City:NEWLAND
Mailing Address - State:NC
Mailing Address - Zip Code:28657-0489
Mailing Address - Country:US
Mailing Address - Phone:828-733-1062
Mailing Address - Fax:828-733-5831
Practice Address - Street 1:358 BEECH ST
Practice Address - Street 2:
Practice Address - City:NEWLAND
Practice Address - State:NC
Practice Address - Zip Code:28657-0489
Practice Address - Country:US
Practice Address - Phone:828-733-1062
Practice Address - Fax:828-733-5831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408272Medicaid