Provider Demographics
NPI:1679617658
Name:HOMEBRIDGE HEALTH CARE
Entity type:Organization
Organization Name:HOMEBRIDGE HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-827-9543
Mailing Address - Street 1:11279 DEEP BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:MAXTON
Mailing Address - State:NC
Mailing Address - Zip Code:28364-8958
Mailing Address - Country:US
Mailing Address - Phone:910-844-7049
Mailing Address - Fax:910-844-2018
Practice Address - Street 1:605 MLK JR RD
Practice Address - Street 2:
Practice Address - City:MAXTON
Practice Address - State:NC
Practice Address - Zip Code:28364-8958
Practice Address - Country:US
Practice Address - Phone:910-844-7049
Practice Address - Fax:910-844-2018
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOMEBRIDGE HEALTH CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-16
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251F00000X, 253Z00000X, 374700000X
NC251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251F00000XAgenciesHome Infusion
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No374700000XNursing Service Related ProvidersTechnicianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6601376OtherPERSONAL CARE SERVICES