Provider Demographics
NPI:1558578609
Name:INTERIM HEALTHCARE OF THE TRIAD, INC.
Entity Type:Organization
Organization Name:INTERIM HEALTHCARE OF THE TRIAD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:PILKINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-206-7208
Mailing Address - Street 1:2526 WARD BLVD
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-1600
Mailing Address - Country:US
Mailing Address - Phone:252-243-7808
Mailing Address - Fax:252-243-7385
Practice Address - Street 1:154 AMENDMENT AVE STE 106
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-3156
Practice Address - Country:US
Practice Address - Phone:803-324-4166
Practice Address - Fax:803-324-7449
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTERIM HEALTHCARE OF THE TRIAD, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-17
Last Update Date:2017-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCHPC-125251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC421580Medicare Oscar/Certification