Provider Demographics
NPI:1215072376
Name:ASSURED CARE
Entity type:Organization
Organization Name:ASSURED CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:LOVELLA
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-670-0487
Mailing Address - Street 1:6977 NEXUS CT. SUITE 104
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-2651
Mailing Address - Country:US
Mailing Address - Phone:910-223-0032
Mailing Address - Fax:910-223-0255
Practice Address - Street 1:6977 NEXUS CT. SUITE 104
Practice Address - Street 2:SUITE 101
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-2651
Practice Address - Country:US
Practice Address - Phone:910-223-0032
Practice Address - Fax:910-223-0255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC2449251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3418004Medicaid