Provider Demographics
NPI:1912673237
Name:COMFORTING MOMENTS HOME CARE INC
Entity Type:Organization
Organization Name:COMFORTING MOMENTS HOME CARE INC
Other - Org Name:COMFORTING MOMENTS HOME HEALTH CARE LLC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KHADIJA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCREARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-299-8549
Mailing Address - Street 1:3428 ANN FRANKLIN CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-7643
Mailing Address - Country:US
Mailing Address - Phone:170-429-9854
Mailing Address - Fax:
Practice Address - Street 1:3428 ANN FRANKLIN CT
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-7643
Practice Address - Country:US
Practice Address - Phone:170-429-9854
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-17
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No251B00000XAgenciesCase ManagementGroup - Single Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC872024012Medicaid
NC000000000Medicaid
NC000249029Medicaid