=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255415402
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HYVIVHOMEHEALTHAGENCY,INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/24/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2421 DALITY DR
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27604-1291
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-539-8604
-----------------------------------------------------
Fax | 919-255-6312
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2421 DALITY DR
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27604-1291
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-539-8604
-----------------------------------------------------
Fax | 919-255-6312
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AGENCY DIRECTOR
-----------------------------------------------------
Name | MR. HYACIENTH ONYEBUCHI II
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 919-539-8604
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | HC3268
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------