Provider Demographics
NPI:1083643381
Name:COMMUNITY HOME CARE AND HOSPICE JOHNSTON INC
Entity Type:Organization
Organization Name:COMMUNITY HOME CARE AND HOSPICE JOHNSTON INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE ATTORNEY
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HALE
Authorized Official - Suffix:
Authorized Official - Credentials:JDRN
Authorized Official - Phone:252-467-1393
Mailing Address - Street 1:800 TIFFANY BLVD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-1946
Mailing Address - Country:US
Mailing Address - Phone:252-467-1393
Mailing Address - Fax:252-937-2647
Practice Address - Street 1:800 TIFFANY BLVD
Practice Address - Street 2:SUITE 209
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-1946
Practice Address - Country:US
Practice Address - Phone:252-467-1393
Practice Address - Fax:252-937-2647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC001E8OtherBLUE CROSS BLUE SHIELD
NC3401588Medicaid
NC=========OtherTRICARE
NC3401588Medicaid