Provider Demographics
NPI:1639596232
Name:PHIBAM DEVOTED HOME CARE
Entity Type:Organization
Organization Name:PHIBAM DEVOTED HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATE
Authorized Official - Middle Name:
Authorized Official - Last Name:LYONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-786-7438
Mailing Address - Street 1:5312 SIX FORKS RD STE 108
Mailing Address - Street 2:SAME AS ABOVE
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-4458
Mailing Address - Country:US
Mailing Address - Phone:919-786-7438
Mailing Address - Fax:
Practice Address - Street 1:5312 SIX FORKS RD STE 108
Practice Address - Street 2:SAME AS ABOVE
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-4458
Practice Address - Country:US
Practice Address - Phone:919-786-7438
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-21
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC130160253Z00000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care