1225276868 NPI number — ULTIMATE FAMILY CARE HOME INC.

Table of content: (NPI 1225276868)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225276868 NPI number — ULTIMATE FAMILY CARE HOME INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ULTIMATE FAMILY CARE HOME INC.
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:
ULTIMATE HEALTHCARE SERVICES INC.
Provider Other Organization Name Type Code:
4
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:
1225276868
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/06/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
817 S 2ND ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SMITHFIELD
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27577-4369
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-880-3144
Provider Business Mailing Address Fax Number:
919-550-2163

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
817 S 2ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SMITHFIELD
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27577-4369
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-880-3144
Provider Business Practice Location Address Fax Number:
919-550-2163
Provider Enumeration Date:
02/04/2009

Additional Information

Authorized Official

Authorized Official Last Name:
EZUMA
Authorized Official First Name:
INNOCENT
Authorized Official Middle Name:
OBIEZIRIKE
Authorized Official Title or Position:
CHAIRMAN
Authorized Official Telephone Number:
919-880-3144

Provider Taxonomy Codes

  • Taxonomy code: 311ZA0620X , with the licence number:  FCL051038 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 311ZA0620X , with the licence number: FCL051050 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 311ZA0620X , with the licence number: MHL051203 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 311ZA0620X , with the licence number: MHL051192 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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