Healthcare Provider Details

I. General information

NPI: 1275689242
Provider Name (Legal Business Name): GRANVILLE-VANCE DISTRICT HEALTH DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 12/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 CHARLES ROLLINS ROAD
HENDERSON NC
27536-0000
US

IV. Provider business mailing address

101 HUNT ST PO BOX 367
OXFORD NC
27565-3414
US

V. Phone/Fax

Practice location:
  • Phone: 252-492-5831
  • Fax:
Mailing address:
  • Phone: 919-693-2141
  • Fax: 919-693-8517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. WILTON RODWELL DRAKE JR.
Title or Position: HEALTH DIRECTOR
Credential: MD
Phone: 96196932141