Provider Demographics
NPI:1174069132
Name:WILMINGTON NC HOMECARE LLC
Entity type:Organization
Organization Name:WILMINGTON NC HOMECARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER/PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:DORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-228-1866
Mailing Address - Street 1:3205 RANDALL PKWY
Mailing Address - Street 2:STE 127
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-2568
Mailing Address - Country:US
Mailing Address - Phone:910-777-5926
Mailing Address - Fax:910-777-5962
Practice Address - Street 1:3205 RANDALL PKWY
Practice Address - Street 2:STE 127
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-2568
Practice Address - Country:US
Practice Address - Phone:910-777-5926
Practice Address - Fax:910-777-5962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-16
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC2392253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care