Provider Demographics
NPI:1457771990
Name:CPS HOME CARE, INC
Entity Type:Organization
Organization Name:CPS HOME CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:HODGES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:877-213-3533
Mailing Address - Street 1:1700 E ASH ST STE 301
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27530-4097
Mailing Address - Country:US
Mailing Address - Phone:877-213-3533
Mailing Address - Fax:877-213-7622
Practice Address - Street 1:1700 E ASH ST STE 301
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-4097
Practice Address - Country:US
Practice Address - Phone:877-213-3533
Practice Address - Fax:877-213-7622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-23
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6602249251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6602249Medicaid