Healthcare Provider Details

I. General information

NPI: 1013077031
Provider Name (Legal Business Name): ST. VINCENT HOME CARE SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 03/31/2022
Certification Date: 03/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1302 E. ASH STREET
GOLDSBORO NC
27530-5106
US

IV. Provider business mailing address

1302 E. ASH STREET
GOLDSBORO NC
27530-5106
US

V. Phone/Fax

Practice location:
  • Phone: 919-731-4850
  • Fax: 919-731-4855
Mailing address:
  • Phone: 919-731-4850
  • Fax: 919-731-4855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberHC3584
License Number StateNC

VIII. Authorized Official

Name: SHANNAN ALICIA TOWNSEND
Title or Position: ADMINISTRATOR
Credential: M.E.D
Phone: 919-344-4150