NPIMap

Organization Active NPI

Avid Health at Home North Carolina

  • In Home Supportive Care Agency
  • Jacksonville, NC
National Provider Identifier
1720229784
Registry record updated Nov 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
In Home Supportive Care AgencyTaxonomy code 253Z00000X
License
HC1337 Issued in NC
Legal business name
AVID HEALTH AT HOME NORTH CAROLINA
Practice address
445 Western Blvd Ste N
Jacksonville, NC 28546-6852
Phone
(910) 353-9788
Fax
(910) 353-9895
NPI assigned
Mar 20, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2024

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

Authorized official

Name
Jennifer Lentz
Title
Ceo
Phone
(910) 728-4668

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X HC1337 NC
Nursing Care Agency 251J00000X HC1337 NC
In Home Supportive Care Agency 253Z00000X HC1337 NC Primary

Addresses

Primary practice location

445 Western Blvd Ste N
Jacksonville, NC 28546-6852

Mailing address

1508 Military Cutoff Rd Ste 304
Wilmington, NC 28403-5730
Phone (910) 343-9996

Other identifiers 1

IdentifierTypeStateIssuer
6601827MedicaidNC

Other names 1

  • Avid Health at Home NC Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Avid Health at Home NC9 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

445 Western Blvd
Ste N
Jacksonville, NC 28546
Phone (910) 353-9788

1715 Country Club Rd
Ste C
Jacksonville, NC 28546

NPI Registry JSON

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

{
    "created_epoch": "1237507200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730937600000",
    "number": "1720229784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1508 MILITARY CUTOFF RD STE 304",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284035730",
            "telephone_number": "910-343-9996",
            "fax_number": "910-343-0352"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "445 WESTERN BLVD STE N",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285466852",
            "telephone_number": "910-353-9788",
            "fax_number": "910-353-9895"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVID HEALTH AT HOME NORTH CAROLINA",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-20",
        "last_updated": "2024-11-07",
        "certification_date": "2024-11-07",
        "status": "A",
        "authorized_official_last_name": "LENTZ",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "910-728-4668"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "NC",
            "license": "HC1337",
            "primary": false
        },
        {
            "code": "251J00000X",
            "taxonomy_group": "",
            "desc": "Nursing Care",
            "state": "NC",
            "license": "HC1337",
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "NC",
            "license": "HC1337",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6601827",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avid Health at Home NC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jacksonville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.