Healthcare Provider Details

I. General information

NPI: 1629303003
Provider Name (Legal Business Name): PHILLIPS HOME HEALTH CARE AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2009
Last Update Date: 10/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 TARBORO ST W SUITE 4&5
WILSON NC
27893-4771
US

IV. Provider business mailing address

PO BOX 1391
WILSON NC
27894-1391
US

V. Phone/Fax

Practice location:
  • Phone: 252-246-9700
  • Fax:
Mailing address:
  • Phone: 252-246-9700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHC3914
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. RENNARD NONE HARRIS
Title or Position: CEO/DIRECTOR
Credential:
Phone: 252-246-9700