Provider Demographics
NPI:1427727395
Name:MCCLAIN'S RESIDENTIAL HOME CARE AGENCY LLC
Entity type:Organization
Organization Name:MCCLAIN'S RESIDENTIAL HOME CARE AGENCY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:OLDPA
Authorized Official - Last Name:MCCLAIN
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:980-236-7218
Mailing Address - Street 1:5801 EXECUTIVE CENTER DRIVE SUITE #102
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28212
Mailing Address - Country:US
Mailing Address - Phone:980-207-3006
Mailing Address - Fax:980-430-3225
Practice Address - Street 1:4921 ALBEMARLE ROAD
Practice Address - Street 2:STE# 116
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205
Practice Address - Country:US
Practice Address - Phone:980-236-7218
Practice Address - Fax:980-236-7237
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MCCLAIN' S RESIDENTIAL HOME CARE AGENCY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-09-13
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care