Provider Demographics
NPI:1922107531
Name:ELDERCARE IN-HOME CARE, INC
Entity type:Organization
Organization Name:ELDERCARE IN-HOME CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ACCOUNTING & HR
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:FORTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-332-2346
Mailing Address - Street 1:1003 OLDE WATERFORD WAY STE 2C
Mailing Address - Street 2:
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-4168
Mailing Address - Country:US
Mailing Address - Phone:910-332-2346
Mailing Address - Fax:910-371-3462
Practice Address - Street 1:3408 WILSHIRE BLVD STE 100B
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-4340
Practice Address - Country:US
Practice Address - Phone:910-395-5003
Practice Address - Fax:910-392-6076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408344Medicaid