1114068764 NPI number — CENTRAL HOME HEALTH INCORPORATED

Table of content: (NPI 1114068764)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114068764 NPI number — CENTRAL HOME HEALTH INCORPORATED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL HOME HEALTH INCORPORATED
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:
6
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:
1114068764
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/26/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
507 LINWOOD AVE
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:
27701-4427
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-682-6877
Provider Business Mailing Address Fax Number:
919-682-3611

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
507 LINWOOD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DURHAM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27701-4427
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-682-6877
Provider Business Practice Location Address Fax Number:
919-682-3611
Provider Enumeration Date:
02/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BROWN
Authorized Official First Name:
THELMA
Authorized Official Middle Name:
B
Authorized Official Title or Position:
PRESIDENT CEO ADMINISTRATOR
Authorized Official Telephone Number:
919-682-6877

Provider Taxonomy Codes

  • Taxonomy code: 311ZA0620X , with the licence number:  FCL032069 , 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)

  • Identifier: 7804639 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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