Healthcare Provider Details

I. General information

NPI: 1639596232
Provider Name (Legal Business Name): PHIBAM DEVOTED HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2014
Last Update Date: 03/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5312 SIX FORKS RD STE 108 SAME AS ABOVE
RALEIGH NC
27609-4458
US

IV. Provider business mailing address

5312 SIX FORKS RD STE 108 SAME AS ABOVE
RALEIGH NC
27609-4458
US

V. Phone/Fax

Practice location:
  • Phone: 919-786-7438
  • Fax:
Mailing address:
  • Phone: 919-786-7438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number130160
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number130160
License Number StateNC

VIII. Authorized Official

Name: MRS. KATE LYONS
Title or Position: AGENCY DIRECTOR
Credential:
Phone: 919-786-7438