Provider Demographics
NPI:1396465795
Name:FOUR OAKS HOME CARE SERVICES LLC PART 2
Entity type:Organization
Organization Name:FOUR OAKS HOME CARE SERVICES LLC PART 2
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:UCHENNA
Authorized Official - Middle Name:JUNIOR
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-491-8231
Mailing Address - Street 1:2451 CROASDAILE FARM PKWY STE 107
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-1466
Mailing Address - Country:US
Mailing Address - Phone:336-491-8231
Mailing Address - Fax:
Practice Address - Street 1:2451 CROASDAILE FARM PKWY STE 107
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-1466
Practice Address - Country:US
Practice Address - Phone:336-491-8231
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FOUR OAKS HOME CARE SERVICES LLC- PART 1
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251J00000XAgenciesNursing Care
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)