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NPI Code Detail

MEDICARE: IDELLA'S CARE HOME

MEDICARE: IDELLA'S CARE HOME
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
1251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1669998001
Entity Type Code : Organization
Provider Name (Legal Business Name) : IDELLA'S CARE HOME
Provider Business Mailing Address
First Line : 912 PRISTINE LN
Second Line :
City : ROLESVILLE
State : NC
Zip : 27571-9307
Country : US
Telephone Number : 252-213-6081
Fax Number :
Provider Business Practice Location Address
First Line : 2912 LEE CT # 9A
Second Line :
City : GREENVILLE
State : NC
Zip : 27834
Country : US
Telephone Number : 252-213-6081
Fax Number :
Authorized Official
Title or Position : OWNER
Name : EUNICE ESSIEN-HART
Credential :
Telephone Number : 252-213-6081
Provider Enumeration Date : 08/17/2017
Last Update Date : 08/10/2018

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Directions to “IDELLA'S CARE HOME ” Practice Location

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