Provider Demographics
NPI:1427024686
Name:DAVIDSON HOME HEALTH, INC.
Entity Type:Organization
Organization Name:DAVIDSON HOME HEALTH, INC.
Other - Org Name:HOME HEALTH PROFESSIONALS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NICK
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLEDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-679-8852
Mailing Address - Street 1:PO BOX 559
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27293-0559
Mailing Address - Country:US
Mailing Address - Phone:336-249-0382
Mailing Address - Fax:336-249-0224
Practice Address - Street 1:1594 OLD US HIGHWAY 52
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27295-1240
Practice Address - Country:US
Practice Address - Phone:336-249-0382
Practice Address - Fax:336-249-0224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-27
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC0358251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3407134Medicaid
NC347134Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER