Provider Demographics
NPI:1477678456
Name:COUNTY OF DAVIE
Entity Type:Organization
Organization Name:COUNTY OF DAVIE
Other - Org Name:DAVIE COUNTY HOME HEALTH AND HOSPICE AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEALTH DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-753-6750
Mailing Address - Street 1:210 HOSPITAL STREET
Mailing Address - Street 2:POST OFFICE BOX 848
Mailing Address - City:MOCKSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27028-0848
Mailing Address - Country:US
Mailing Address - Phone:336-753-6750
Mailing Address - Fax:336-751-0335
Practice Address - Street 1:642 WILKESBORO ST
Practice Address - Street 2:
Practice Address - City:MOCKSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27028-2051
Practice Address - Country:US
Practice Address - Phone:336-753-6750
Practice Address - Fax:336-751-0335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2009-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408191Medicaid