Provider Demographics
NPI:1740322163
Name:HARVEST HOMECARE, LLC
Entity type:Organization
Organization Name:HARVEST HOMECARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:WILLIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:704-932-9357
Mailing Address - Street 1:208 NELLIE YALE PL
Mailing Address - Street 2:
Mailing Address - City:KANNAPOLIS
Mailing Address - State:NC
Mailing Address - Zip Code:28083-7821
Mailing Address - Country:US
Mailing Address - Phone:704-932-9357
Mailing Address - Fax:866-496-6154
Practice Address - Street 1:208 NELLIE YALE PL
Practice Address - Street 2:
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28083-7821
Practice Address - Country:US
Practice Address - Phone:704-932-9357
Practice Address - Fax:866-496-6154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3483251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCHC3483Medicaid