NPIMap

Organization Active NPI

Personal Home Care of North Carolina, LLC

  • Home Health Agency
  • Cary, NC
National Provider Identifier
1306035076
Registry record updated Jul 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
PERSONAL HOME CARE OF NORTH CAROLINA, LLC
Practice address
119 SW Maynard Rd Ste 170a
Cary, NC 27511-4472
Phone
(919) 230-7231
NPI assigned
Oct 18, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ivan Belov
Title
Director
Phone
(704) 522-6144

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X HC2786 NC
Home Health Agency 251E00000X Primary
In Home Supportive Care Agency 253Z00000X

Addresses

Primary practice location

119 SW Maynard Rd Ste 170a
Cary, NC 27511-4472

Mailing address

1515 Mockingbird LN Ste 520
Charlotte, NC 28209-3297
Phone (704) 522-6144

Other names 1

  • PHC Home Health Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210416000123 NC Part A Provider - Home Health Agency 8628111812 Practice locations: Cary, NC

Home health agency certification: CCN 347337

Legal name
PERSONAL HOME CARE OF NORTH CAROLINA, LLC
Doing business as
PHC HOME HEALTH
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Nov 29, 2021
Last certification
Nov 16, 2021
Ownership / control type
Proprietary
Organization structure
LLCProprietary
Incorporated
Mar 25, 2003 in NC
Enrollment address
119 SW Maynard Rd
Ste 170a
Cary, NC 27511-4472
HHA Branch

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Home health agency

Medicare Care Compare
Listed as
PHC Home Health-WakeCCN 347337
Overall star rating
3.5 of 5
Ownership
Proprietary
Certified
Nov 29, 2021
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D2236752PHC Home Health119 SW Maynard St Suite 170, Cary, NC 27511Certificate of waiverSep 19, 2027

National Provider Directory

National Provider Directory
Tax ID family
Personal Home Care of North Carolina LLC9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Locations

119 SW Maynard Rd
Ste 170A
Cary, NC 27511
Phone (919) 230-7231

1515 Mockingbird Ln
Ste 801
Charlotte, NC 28209

Ownership & related parties

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Yana Rachinskaya Individual 5% Or Greater Direct Ownership Interest Mar 25, 2003 33%
Ivan Bevlov Individual 5% Or Greater Direct Ownership Interest Mar 25, 2003 67%
General Partnership Interest Mar 25, 2003
Corporate Officer Mar 25, 2003
W-2 Managing Employee Mar 1, 2021

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1192665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657670400000",
    "number": "1306035076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 MOCKINGBIRD LN STE 520",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282093297",
            "telephone_number": "704-522-6144",
            "fax_number": "704-522-6145"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "119 SW MAYNARD RD STE 170A",
            "city": "CARY",
            "state": "NC",
            "postal_code": "275114472",
            "telephone_number": "919-230-7231"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERSONAL HOME CARE OF NORTH CAROLINA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-18",
        "last_updated": "2022-07-13",
        "certification_date": "2022-07-13",
        "status": "A",
        "authorized_official_last_name": "BELOV",
        "authorized_official_first_name": "IVAN",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "704-522-6144"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "NC",
            "license": "HC2786",
            "primary": false
        },
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PHC Home Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cary, NC

Sources for this page

Verify at the official NPI Registry.