Provider Demographics
NPI:1417940669
Name:NORTHERN HOME CARE - CANA DIVISION
Entity Type:Organization
Organization Name:NORTHERN HOME CARE - CANA DIVISION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:J
Authorized Official - Last Name:ZIZZAMIA
Authorized Official - Suffix:JR
Authorized Official - Credentials:RN
Authorized Official - Phone:910-815-3122
Mailing Address - Street 1:2334 S 41ST ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-5502
Mailing Address - Country:US
Mailing Address - Phone:910-815-3122
Mailing Address - Fax:910-815-3111
Practice Address - Street 1:15397 FANCY GAP HWY
Practice Address - Street 2:SUITE 2
Practice Address - City:CANA
Practice Address - State:VA
Practice Address - Zip Code:24317-3635
Practice Address - Country:US
Practice Address - Phone:276-755-4766
Practice Address - Fax:276-755-4225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-23
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAN/A251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA442206OtherANTHEM
VA004973259Medicaid
VA442206OtherANTHEM