=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942461694
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMFORT HEALTHCARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/24/2008
-----------------------------------------------------
Last Update Date | 06/24/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 102 WALKER AVENUE
-----------------------------------------------------
City | NORLINA
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27563-9292
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-456-0038
-----------------------------------------------------
Fax | 252-456-0039
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 58218
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27658-8218
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-291-6596
-----------------------------------------------------
Fax | 252-456-0039
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | OGBONNAYA UDE ANYANSO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 919-291-6596
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | HC2964
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------