Provider Demographics
NPI:1457991192
Name:ABC CARE LP
Entity Type:Organization
Organization Name:ABC CARE LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:OLUFEMI
Authorized Official - Last Name:ABE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-817-9174
Mailing Address - Street 1:212 PINE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-6832
Mailing Address - Country:US
Mailing Address - Phone:919-817-9174
Mailing Address - Fax:
Practice Address - Street 1:212 PINE RIDGE DR
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-6832
Practice Address - Country:US
Practice Address - Phone:919-817-9174
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-10
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1931370Medicaid