Healthcare Provider Details

I. General information

NPI: 1396972782
Provider Name (Legal Business Name): ULTIMATE HEALTHCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2009
Last Update Date: 11/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3310 NC HIGHWAY 210
SMITHFIELD NC
27577-6914
US

IV. Provider business mailing address

3310 NC HIGHWAY 210
SMITHFIELD NC
27577-6914
US

V. Phone/Fax

Practice location:
  • Phone: 919-880-3144
  • Fax: 919-550-2163
Mailing address:
  • Phone: 919-880-3144
  • Fax: 919-550-2163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberHC3818
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberFCL035025
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberFCL035026
License Number StateNC

VIII. Authorized Official

Name: LILLIAN OKORO
Title or Position: ADMINISTRATOR
Credential:
Phone: 919-880-3144