Provider Demographics
NPI:1699827105
Name:INTERIM HEALTHCARE OF THE EASTERN CAROLINAS, INC
Entity Type:Organization
Organization Name:INTERIM HEALTHCARE OF THE EASTERN CAROLINAS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT - OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BYRD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-642-2106
Mailing Address - Street 1:PO BOX 2249
Mailing Address - Street 2:
Mailing Address - City:WHITEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28472-7249
Mailing Address - Country:US
Mailing Address - Phone:910-642-2106
Mailing Address - Fax:910-640-2506
Practice Address - Street 1:126 W FREMONT STREET
Practice Address - Street 2:
Practice Address - City:BURGAW
Practice Address - State:NC
Practice Address - Zip Code:28425-5099
Practice Address - Country:US
Practice Address - Phone:910-259-7075
Practice Address - Fax:910-259-9249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2019-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3651251E00000X
253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6601720Medicaid
NC7100602Medicaid