Provider Demographics
NPI:1063050219
Name:BARBARA KING HOME AGENCY INC
Entity type:Organization
Organization Name:BARBARA KING HOME AGENCY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LOCKSLEY
Authorized Official - Middle Name:LISA
Authorized Official - Last Name:MCFADDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-354-5459
Mailing Address - Street 1:2932 BREEZEWOOD AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-5455
Mailing Address - Country:US
Mailing Address - Phone:910-354-5459
Mailing Address - Fax:910-304-6787
Practice Address - Street 1:2932 BREEZEWOOD AVE STE 103
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-5455
Practice Address - Country:US
Practice Address - Phone:910-354-5459
Practice Address - Fax:910-304-6787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-18
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1871839332Medicaid