Provider Demographics
NPI:1073717880
Name:HOME HEALTH ALLIANCE, INC.
Entity Type:Organization
Organization Name:HOME HEALTH ALLIANCE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DARYL
Authorized Official - Middle Name:
Authorized Official - Last Name:HAGINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-860-9793
Mailing Address - Street 1:804 STAMPER RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-4379
Mailing Address - Country:US
Mailing Address - Phone:910-483-9903
Mailing Address - Fax:910-483-9904
Practice Address - Street 1:804 STAMPER RD
Practice Address - Street 2:SUITE 201
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-4379
Practice Address - Country:US
Practice Address - Phone:910-483-9903
Practice Address - Fax:910-483-9904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3028251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408452Medicaid