Provider Demographics
NPI:1558039966
Name:FIRST-WATCH HOMECARE, LLC
Entity Type:Organization
Organization Name:FIRST-WATCH HOMECARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GEANDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:TILLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-425-9513
Mailing Address - Street 1:4801 DANUBE LN APT 1106
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-1858
Mailing Address - Country:US
Mailing Address - Phone:919-425-9513
Mailing Address - Fax:
Practice Address - Street 1:4801 DANUBE LN APT 1106
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-1858
Practice Address - Country:US
Practice Address - Phone:919-425-9513
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC4523704OtherNORTH CAROLINA