Healthcare Provider Details

I. General information

NPI: 1861566408
Provider Name (Legal Business Name): MARTIN-TYRRELL-WASHINGTON DISTRICT HEALTH DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

198 NC HIGHWAY 45 N
PLYMOUTH NC
27962-9232
US

IV. Provider business mailing address

198 NC HIGHWAY 45 N
PLYMOUTH NC
27962-9232
US

V. Phone/Fax

Practice location:
  • Phone: 252-793-3023
  • Fax:
Mailing address:
  • Phone: 252-793-3023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNC

VIII. Authorized Official

Name: KATHERINE DAVIS
Title or Position: HOME CARE DIRECTOR
Credential:
Phone: 252-791-3152