Healthcare Provider Details

I. General information

NPI: 1134352990
Provider Name (Legal Business Name): BRYANT'S FAMILY HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2009
Last Update Date: 01/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 N PATTERSON ST
MAXTON NC
28364-1735
US

IV. Provider business mailing address

110 N PATTERSON ST
MAXTON NC
28364-1735
US

V. Phone/Fax

Practice location:
  • Phone: 910-844-2500
  • Fax: 910-844-2500
Mailing address:
  • Phone: 910-844-2500
  • Fax: 910-844-2504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License NumberHC3907
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberHC3907
License Number StateNC

VIII. Authorized Official

Name: MR. RYAN CARNELL BRYANT
Title or Position: OWNER
Credential:
Phone: 910-844-2500