Provider Demographics
NPI:1871771477
Name:NATIVE ANGELS HOME CARE AGENCY INC
Entity type:Organization
Organization Name:NATIVE ANGELS HOME CARE AGENCY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BOBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBS-GHAFFAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-735-1541
Mailing Address - Street 1:4701 FAYETTEVILLE RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-2622
Mailing Address - Country:US
Mailing Address - Phone:910-735-1547
Mailing Address - Fax:910-735-1550
Practice Address - Street 1:2008 LITHO PL
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-2518
Practice Address - Country:US
Practice Address - Phone:910-483-1357
Practice Address - Fax:910-483-8609
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NATIVE ANGELS HOME CARE AGENCY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC 34893747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty