=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952771958
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEALTHACCESS, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2015
-----------------------------------------------------
Last Update Date | 10/05/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 750 KENANSVILLE BYP
-----------------------------------------------------
City | KENANSVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28349-9064
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-296-0819
-----------------------------------------------------
Fax | 910-296-0482
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 8125
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27835-8125
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-847-2000
-----------------------------------------------------
Fax | 252-847-7910
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JOAN WYNN
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 252-847-2000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number | HC0053
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------