Provider Demographics
NPI:1235598772
Name:CORNELIA NIXON DAVIS, INC.
Entity Type:Organization
Organization Name:CORNELIA NIXON DAVIS, INC.
Other - Org Name:DAVIS HOME CARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-686-7195
Mailing Address - Street 1:1011 PORTERS NECK RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-9196
Mailing Address - Country:US
Mailing Address - Phone:910-686-7195
Mailing Address - Fax:910-686-7592
Practice Address - Street 1:1013 PORTERS NECK RD
Practice Address - Street 2:SUITE 130
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28411-8130
Practice Address - Country:US
Practice Address - Phone:910-686-7195
Practice Address - Fax:910-686-7592
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CORNELIA NIXON DAVIS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-02-12
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC4177253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care