Provider Demographics
NPI:1275808651
Name:EASTERN LIFE HOME HEALTH CARE.LLC
Entity Type:Organization
Organization Name:EASTERN LIFE HOME HEALTH CARE.LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:EBONY
Authorized Official - Middle Name:NANTELLE
Authorized Official - Last Name:BLOUNT
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:252-945-2362
Mailing Address - Street 1:140 CONCORD DR APT 8
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-6495
Mailing Address - Country:US
Mailing Address - Phone:252-945-2362
Mailing Address - Fax:
Practice Address - Street 1:140 CONCORD DR APT 8
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-6495
Practice Address - Country:US
Practice Address - Phone:252-945-2362
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EASTERN LIFE HOME HEALTH CARE.LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-03-19
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1248402251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health