Provider Demographics
NPI:1699772939
Name:MEDICAL HOME HEALTH OF CABARRUS,INC
Entity type:Organization
Organization Name:MEDICAL HOME HEALTH OF CABARRUS,INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RENE'
Authorized Official - Middle Name:HAM
Authorized Official - Last Name:HAMMON
Authorized Official - Suffix:
Authorized Official - Credentials:CRTT, RCP
Authorized Official - Phone:704-782-2188
Mailing Address - Street 1:320 COPPERFIELD BLVD NE STE B
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-2431
Mailing Address - Country:US
Mailing Address - Phone:704-782-2188
Mailing Address - Fax:704-792-1443
Practice Address - Street 1:320 COPPERFIELD BLVD NE STE B
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2431
Practice Address - Country:US
Practice Address - Phone:704-782-2188
Practice Address - Fax:704-792-1443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00085332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7700056Medicaid
NC0487ZOtherBLUE CROSS BLUE SHIELD
NC7700056Medicaid