Provider Demographics
NPI:1982737250
Name:QUALICARE OF GRAHAM LLC
Entity type:Organization
Organization Name:QUALICARE OF GRAHAM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNEROPERATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:POLLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BUCHANAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-479-4790
Mailing Address - Street 1:750 TALLULAH ROAD
Mailing Address - Street 2:
Mailing Address - City:ROBBINSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28771-9701
Mailing Address - Country:US
Mailing Address - Phone:828-479-4790
Mailing Address - Fax:828-479-3203
Practice Address - Street 1:750 TALLULAH ROAD
Practice Address - Street 2:
Practice Address - City:ROBBINSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28771-9701
Practice Address - Country:US
Practice Address - Phone:828-479-4790
Practice Address - Fax:828-479-3203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC2553251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408038OtherMEDICAID PROVIDER NUMBER
NC6601093OtherMEDICAID PROVIDER NUMBER