Provider Demographics
NPI:1417152554
Name:E T CARE HEALTH AND MEDICAL
Entity Type:Organization
Organization Name:E T CARE HEALTH AND MEDICAL
Other - Org Name:E T CARE HEALTH AND MEDICAL SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECT OWNER, PRODUCT MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:KAYE
Authorized Official - Last Name:BROCK
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:336-896-0408
Mailing Address - Street 1:PO BOX 11348
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27116-1348
Mailing Address - Country:US
Mailing Address - Phone:336-896-0408
Mailing Address - Fax:336-896-0409
Practice Address - Street 1:8007 N POINT BLVD STE F
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-3268
Practice Address - Country:US
Practice Address - Phone:336-896-0408
Practice Address - Fax:336-896-0409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00863332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7795387Medicaid
NC7795178Medicaid
NC7704135Medicaid
NC7795387Medicaid