Provider Demographics
NPI:1326935099
Name:STATE OF NORTH CAROLINA HOME CARE
Entity type:Organization
Organization Name:STATE OF NORTH CAROLINA HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:M
Authorized Official - Last Name:BROOKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-824-0860
Mailing Address - Street 1:180 MEADOWSWEET CT
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27107-6055
Mailing Address - Country:US
Mailing Address - Phone:267-824-0860
Mailing Address - Fax:
Practice Address - Street 1:180 MEADOWSWEET CT
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27107-6055
Practice Address - Country:US
Practice Address - Phone:267-824-0860
Practice Address - Fax:267-824-0860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health