Provider Demographics
NPI:1629221908
Name:VISITING NURSE SERVICE OF DURHAM
Entity Type:Organization
Organization Name:VISITING NURSE SERVICE OF DURHAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHN SUPERVISOR I
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:D
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-560-7700
Mailing Address - Street 1:414 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27701-3720
Mailing Address - Country:US
Mailing Address - Phone:919-560-7700
Mailing Address - Fax:919-560-7740
Practice Address - Street 1:414 E MAIN ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701-3720
Practice Address - Country:US
Practice Address - Phone:919-560-7700
Practice Address - Fax:919-560-7740
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DURHAM COUNTY HEALTH DEPARTMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-30
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC0237251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408001Medicaid