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General NPI Number Information
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NPI Number | 1275808651
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Entity Type | Organization
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Legal Business Name | EASTERN LIFE HOME HEALTH CARE.LLC
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Dates
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Enumeration Date | 03/19/2012
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Last Update Date | 03/19/2012
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Provider Practice Location Address
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Address Line | 140 CONCORD DR APT 8
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City | GREENVILLE
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State | NC
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Zip | 27834-6495
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Country | US
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Telephone | 252-945-2362
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Fax |
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Provider Business Mailing Address
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Address Line | 140 CONCORD DR APT 8
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City | GREENVILLE
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State | NC
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Zip | 27834-6495
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Country | US
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Telephone | 252-945-2362
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MRS. EBONY NANTELLE BLOUNT
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Credential | CNA
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Telephone | 252-945-2362
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 1248402
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License Number State | NC
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