Provider Demographics
NPI:1124010210
Name:MARTIN-TYRRELL-WASHINGTON DISTRICT HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:MARTIN-TYRRELL-WASHINGTON DISTRICT HEALTH DEPARTMENT
Other - Org Name:ROANOKE HOME CARE & HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HOME CARE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:252-791-3152
Mailing Address - Street 1:198 NC HIGHWAY 45 N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:NC
Mailing Address - Zip Code:27962-9232
Mailing Address - Country:US
Mailing Address - Phone:252-791-3138
Mailing Address - Fax:252-791-3158
Practice Address - Street 1:198 NC HIGHWAY 45 N
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:NC
Practice Address - Zip Code:27962-9232
Practice Address - Country:US
Practice Address - Phone:252-791-3138
Practice Address - Fax:252-791-3158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC0523251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3401572Medicaid
NC0024AOtherBLUE CROSS BLUE SHIELD
NC0024AOtherBLUE CROSS BLUE SHIELD