=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124191952
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARTIN-TYRRELL-WASHINGTON DISTRICT HEALTH DEPARTMENT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/17/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 408 BRIDGE STREET
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27925-9757
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-793-3023
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 198 NC HIGHWAY 45 N
-----------------------------------------------------
City | PLYMOUTH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27962-9232
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-793-3023
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | HOME CARE DIRECTOR
-----------------------------------------------------
Name | KATHERINE DAVIS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 252-791-3152
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------