Provider Demographics
NPI:1487786315
Name:OUR HOUSE HOME CARE SERVICE, INC.
Entity type:Organization
Organization Name:OUR HOUSE HOME CARE SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:WENTIERS
Authorized Official - Middle Name:ANTARIO
Authorized Official - Last Name:LONDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-353-2022
Mailing Address - Street 1:PO BOX 8558
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27835-8558
Mailing Address - Country:US
Mailing Address - Phone:252-353-2022
Mailing Address - Fax:252-353-2024
Practice Address - Street 1:323 E ARLINGTON BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5017
Practice Address - Country:US
Practice Address - Phone:252-353-2022
Practice Address - Fax:252-353-2024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC 3473251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6601553Medicaid