Provider Demographics
NPI:1588955223
Name:PROFESSIONAL HOME CARE OF NC
Entity type:Organization
Organization Name:PROFESSIONAL HOME CARE OF NC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-523-7659
Mailing Address - Street 1:PO BOX 27893
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-5048
Mailing Address - Country:US
Mailing Address - Phone:919-523-7659
Mailing Address - Fax:910-867-4955
Practice Address - Street 1:315 BADGER CT
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-3121
Practice Address - Country:US
Practice Address - Phone:919-523-7659
Practice Address - Fax:910-867-4955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-28
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC4395253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care