Provider Demographics
NPI:1497812408
Name:SIMPLE HOME HEALTHCARE
Entity Type:Organization
Organization Name:SIMPLE HOME HEALTHCARE
Other - Org Name:SIMPLY HOME HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JIMIKA
Authorized Official - Middle Name:COLLETTE
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-426-9600
Mailing Address - Street 1:912 HOPE MILLS RD STE B
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-0000
Mailing Address - Country:US
Mailing Address - Phone:910-426-9600
Mailing Address - Fax:910-426-2940
Practice Address - Street 1:912 HOPE MILLS RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4243
Practice Address - Country:US
Practice Address - Phone:910-426-9600
Practice Address - Fax:910-426-2940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3607251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1760557623Medicaid