Provider Demographics
NPI:1538123039
Name:EAST CAROLINA HEALTH - CHOWAN INC
Entity Type:Organization
Organization Name:EAST CAROLINA HEALTH - CHOWAN INC
Other - Org Name:CHOWAN HOSPITAL HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:N
Authorized Official - Last Name:SACKRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-482-6268
Mailing Address - Street 1:PO BOX 607
Mailing Address - Street 2:
Mailing Address - City:EDENTON
Mailing Address - State:NC
Mailing Address - Zip Code:27932-0607
Mailing Address - Country:US
Mailing Address - Phone:252-482-1988
Mailing Address - Fax:252-482-1359
Practice Address - Street 1:100 W. FREEMASON CIRCLE
Practice Address - Street 2:
Practice Address - City:EDENTON
Practice Address - State:NC
Practice Address - Zip Code:27932
Practice Address - Country:US
Practice Address - Phone:252-482-1988
Practice Address - Fax:252-482-1359
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAST CAROLINA HEALTH - CHOWAN INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-13
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC1133251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6600621Medicaid