Provider Demographics
NPI:1932541950
Name:HALIKIERRA COMMUNITY SERVICES, LLC
Entity Type:Organization
Organization Name:HALIKIERRA COMMUNITY SERVICES, LLC
Other - Org Name:HALIKIERRA HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SCALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-226-2001
Mailing Address - Street 1:1316 LANERIDGE CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-8247
Mailing Address - Country:US
Mailing Address - Phone:252-226-2001
Mailing Address - Fax:
Practice Address - Street 1:200 W ASH ST STE 101
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-3657
Practice Address - Country:US
Practice Address - Phone:252-226-2001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-18
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC624190200Medicaid