Healthcare Provider Details

I. General information

NPI: 1437779949
Provider Name (Legal Business Name): ISLAND HOME CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2020
Last Update Date: 04/24/2020
Certification Date: 04/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 ATLANTIC AVE STE 106E
RALEIGH NC
27609-1123
US

IV. Provider business mailing address

PO BOX 98024
RALEIGH NC
27624-8024
US

V. Phone/Fax

Practice location:
  • Phone: 919-588-4435
  • Fax:
Mailing address:
  • Phone: 919-588-4435
  • Fax:

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
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: ISLANDE MITIL
Title or Position: OWNER/DIRECTOR
Credential: RN
Phone: 919-588-4435