Provider Demographics
NPI:1144308933
Name:MEDICAL CENTER HOME CARE LLC
Entity type:Organization
Organization Name:MEDICAL CENTER HOME CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:H
Authorized Official - Last Name:HERRING
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:910-762-7007
Mailing Address - Street 1:908 S 16TH ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-8016
Mailing Address - Country:US
Mailing Address - Phone:910-762-7007
Mailing Address - Fax:910-762-7062
Practice Address - Street 1:908 S 16TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-8016
Practice Address - Country:US
Practice Address - Phone:910-762-7007
Practice Address - Fax:910-762-7062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00200332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0485ROtherBCBS PROVIDER NUMBER
NC7703826Medicaid
NC4773470001Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER