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General NPI Number Information
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NPI Number | 1437779949
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Entity Type | Organization
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Legal Business Name | ISLAND HOME CARE, PLLC
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Dates
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Enumeration Date | 04/24/2020
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Last Update Date | 04/24/2020
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Provider Practice Location Address
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Address Line | 5300 ATLANTIC AVE STE 106E
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City | RALEIGH
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State | NC
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Zip | 27609-1123
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Country | US
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Telephone | 919-588-4435
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 98024
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City | RALEIGH
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State | NC
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Zip | 27624-8024
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Country | US
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Telephone | 919-588-4435
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Fax |
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | ISLANDE MITIL
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Credential | RN
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Telephone | 919-588-4435
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251F00000X
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Taxonomy Name | Home Infusion Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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