Provider Demographics
NPI:1336282128
Name:HOME HEALTH CARE CENTER
Entity Type:Organization
Organization Name:HOME HEALTH CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:GALE
Authorized Official - Middle Name:R
Authorized Official - Last Name:FINCANNON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-262-0566
Mailing Address - Street 1:330 SILVA TERRA DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-2325
Mailing Address - Country:US
Mailing Address - Phone:910-262-0566
Mailing Address - Fax:
Practice Address - Street 1:1204 N LAKE PARK BLVD # G
Practice Address - Street 2:
Practice Address - City:CAROLINA BEACH
Practice Address - State:NC
Practice Address - Zip Code:28428-4163
Practice Address - Country:US
Practice Address - Phone:910-262-0566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7702247Medicaid
NC7702247Medicaid