Provider Demographics
NPI:1396233045
Name:SHINING HEARTS HOME CARE OF NORTH CAROLINA LLC
Entity type:Organization
Organization Name:SHINING HEARTS HOME CARE OF NORTH CAROLINA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HANNAH
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-939-0511
Mailing Address - Street 1:2064 HUNTERS RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MIDWAY PARK
Mailing Address - State:NC
Mailing Address - Zip Code:28544-1609
Mailing Address - Country:US
Mailing Address - Phone:910-539-8800
Mailing Address - Fax:
Practice Address - Street 1:2064 HUNTERS RIDGE DR
Practice Address - Street 2:
Practice Address - City:MIDWAY PARK
Practice Address - State:NC
Practice Address - Zip Code:28544-1609
Practice Address - Country:US
Practice Address - Phone:910-539-8800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-27
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC5010251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCHC5010OtherHOME CARE LICENSE