Provider Demographics
NPI:1902333636
Name:DIANA'S HOMECARE, INC
Entity Type:Organization
Organization Name:DIANA'S HOMECARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-456-8389
Mailing Address - Street 1:2421 CREEK MANOR DR
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-4106
Mailing Address - Country:US
Mailing Address - Phone:704-456-8389
Mailing Address - Fax:704-256-9957
Practice Address - Street 1:616 SAMUEL ADAMS CIR SW
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-0133
Practice Address - Country:US
Practice Address - Phone:704-456-8389
Practice Address - Fax:704-256-9957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-12
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7806485Medicaid