Provider Demographics
NPI:1902968498
Name:MAHJUSTIC HOME HEALTH LLC
Entity Type:Organization
Organization Name:MAHJUSTIC HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:DARNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-858-0883
Mailing Address - Street 1:1710 PERGOLA PL
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-2107
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:704-503-5777
Practice Address - Street 1:1710 PERGOLA PL
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-2107
Practice Address - Country:US
Practice Address - Phone:704-858-0883
Practice Address - Fax:704-503-5777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3194251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6601395Medicaid
NC3418038Medicaid