Provider Demographics
NPI:1992566335
Name:KING'S HOMECARE
Entity type:Organization
Organization Name:KING'S HOMECARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TIARA
Authorized Official - Middle Name:BIANCA
Authorized Official - Last Name:WILEY-KING
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:252-315-4696
Mailing Address - Street 1:1030 N ROGERS LN STE 121
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-6083
Mailing Address - Country:US
Mailing Address - Phone:984-677-4134
Mailing Address - Fax:
Practice Address - Street 1:121 NASH ST W STE 132
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-4012
Practice Address - Country:US
Practice Address - Phone:984-677-4134
Practice Address - Fax:936-209-7972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-22
Last Update Date:2024-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion
No251J00000XAgenciesNursing Care
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No385H00000XRespite Care FacilityRespite Care