MEDICARE: IDEAL HOME HEALTH SERVICES, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	HC1650	NC
2	3747P1801X	Personal Care Attendant
3	253Z00000X	In Home Supportive Care Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578613097
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IDEAL HOME HEALTH SERVICES, INC

Provider Business Mailing Address
First Line	:	1420 EAST CLUB BLVD
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27704
Country	:	US
Telephone Number	:	919-957-8311
Fax Number	:	919-937-9318

Provider Business Practice Location Address
First Line	:	1420 EAST CLUB BLVD
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27704
Country	:	US
Telephone Number	:	919-957-8311
Fax Number	:	919-937-9318

Authorized Official
Title or Position	:	CHIEF ADMINISTRATIVE OFFICER
Name	:	MRS. PATIENCE CHILE NDIKOM
Credential	:	RN, MHA
Telephone Number	:	919-957-8311

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	10/07/2019

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