Provider Demographics
NPI:1639179419
Name:GRANVILLE-VANCE DISTRICT HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:GRANVILLE-VANCE DISTRICT HEALTH DEPARTMENT
Other - Org Name:GRANVILLE-VANCE HOME HEALTH AGENCY
Other - Org Type:Other Name
Authorized Official - Title/Position:NURSING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:LYNNE
Authorized Official - Middle Name:O
Authorized Official - Last Name:ROOKER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:919-693-9103
Mailing Address - Street 1:PO BOX 367
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27565-0367
Mailing Address - Country:US
Mailing Address - Phone:919-693-9106
Mailing Address - Fax:919-693-8006
Practice Address - Street 1:101 HUNT ST
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:NC
Practice Address - Zip Code:27565-3414
Practice Address - Country:US
Practice Address - Phone:919-693-9106
Practice Address - Fax:919-693-8006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC0501251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3407062Medicaid
NC3407062Medicaid