1588071989 NPI number — EXCEPTIONAL SERVICE HOME CARE AGENCY

Table of content: (NPI 1588071989)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588071989 NPI number — EXCEPTIONAL SERVICE HOME CARE AGENCY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EXCEPTIONAL SERVICE HOME CARE AGENCY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588071989
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/06/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3804 ZENITH PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DURHAM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27705-2118
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-294-6595
Provider Business Mailing Address Fax Number:
919-477-4042

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3329 CHAPEL HILL BLVD
Provider Second Line Business Practice Location Address:
SERVICE ROAD, SUIT 100
Provider Business Practice Location Address City Name:
DURHAM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27707-2663
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-408-1230
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/17/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
EASON
Authorized Official First Name:
SANDY
Authorized Official Middle Name:
RENEE
Authorized Official Title or Position:
OWER/CEO
Authorized Official Telephone Number:
919-408-1230

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  HC4646 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 253Z00000X , with the licence number: HC4646 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)