Provider Demographics
NPI:1356530026
Name:NATIVE ANGELS HOME CARE AGENCY INC
Entity type:Organization
Organization Name:NATIVE ANGELS HOME CARE AGENCY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:BOBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBS-GHAFFAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-735-1541
Mailing Address - Street 1:201 EAST LIVERMORE DR
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:NC
Mailing Address - Zip Code:28372-7322
Mailing Address - Country:US
Mailing Address - Phone:910-735-1541
Mailing Address - Fax:910-735-1550
Practice Address - Street 1:113B WEST BROAD ST
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:NC
Practice Address - Zip Code:28337-9005
Practice Address - Country:US
Practice Address - Phone:910-862-3971
Practice Address - Fax:910-862-8467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC34883747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6601764Medicaid