Provider Demographics
NPI:1902571300
Name:ADDAE AT HOME SENIOR SERVICES LLC
Entity Type:Organization
Organization Name:ADDAE AT HOME SENIOR SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:INGRAM
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:910-975-9674
Mailing Address - Street 1:1227 COLE RD
Mailing Address - Street 2:
Mailing Address - City:CANDOR
Mailing Address - State:NC
Mailing Address - Zip Code:27229-9678
Mailing Address - Country:US
Mailing Address - Phone:910-975-9674
Mailing Address - Fax:
Practice Address - Street 1:2211 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-8182
Practice Address - Country:US
Practice Address - Phone:910-975-9674
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-09
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care