Provider Demographics
NPI:1275303026
Name:EXECUTIVE HOME CARE SERVICES, CORP
Entity Type:Organization
Organization Name:EXECUTIVE HOME CARE SERVICES, CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHAWAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DANIELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-933-4195
Mailing Address - Street 1:579 GUTHRIE TURNER RD
Mailing Address - Street 2:
Mailing Address - City:SNOW HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28580-8764
Mailing Address - Country:US
Mailing Address - Phone:252-933-4195
Mailing Address - Fax:800-814-3622
Practice Address - Street 1:579 GUTHRIE TURNER RD
Practice Address - Street 2:
Practice Address - City:SNOW HILL
Practice Address - State:NC
Practice Address - Zip Code:28580-8764
Practice Address - Country:US
Practice Address - Phone:252-933-4195
Practice Address - Fax:800-814-3622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-03
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care