Provider Demographics
NPI:1215957147
Name:MAMA'S TOUCH HOME CARE SERVICES
Entity type:Organization
Organization Name:MAMA'S TOUCH HOME CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:910-618-0445
Mailing Address - Street 1:4908 BARKER TEN MILE RD
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-0137
Mailing Address - Country:US
Mailing Address - Phone:910-618-0445
Mailing Address - Fax:910-618-0455
Practice Address - Street 1:4908 BARKER TEN MILE RD
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-0137
Practice Address - Country:US
Practice Address - Phone:910-618-0873
Practice Address - Fax:910-618-0455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3674251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100114570GMedicaid
OK444924015004OtherBCBS
G92053Medicare UPIN
OK100114570GMedicaid