Healthcare Provider Details

I. General information

NPI: 1063579852
Provider Name (Legal Business Name): FAITH HOME CARE OF NC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 CAROLINA AVE SUITE 103
WASHINGTON NC
27889-3751
US

IV. Provider business mailing address

PO BOX 736
CHOCOWINITY NC
27817
US

V. Phone/Fax

Practice location:
  • Phone: 252-948-0052
  • Fax: 252-948-0059
Mailing address:
  • Phone: 252-948-0052
  • Fax: 252-948-0059

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 Code3747P1801X
TaxonomyPersonal Care Attendant
License NumberHC3405
License Number StateNC

VIII. Authorized Official

Name: MRS. BONITA WRIGHT
Title or Position: AGENCY DIRECTOR
Credential:
Phone: 252-948-0052