Provider Demographics
NPI:1225533714
Name:AVID HEALTH AT HOME NORTH CAROLINA
Entity type:Organization
Organization Name:AVID HEALTH AT HOME NORTH CAROLINA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:LENTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-728-4668
Mailing Address - Street 1:1508 MILITARY CUTOFF RD STE 304
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-5730
Mailing Address - Country:US
Mailing Address - Phone:910-338-5416
Mailing Address - Fax:910-362-9948
Practice Address - Street 1:2640 WILLARD DAIRY RD STE 106
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-8709
Practice Address - Country:US
Practice Address - Phone:919-948-3277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-27
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No385H00000XRespite Care FacilityRespite Care