Provider Demographics
NPI:1720376320
Name:RELIABLE HOME CARE AGENCY
Entity Type:Organization
Organization Name:RELIABLE HOME CARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:BENEDICTA
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:919-308-2339
Mailing Address - Street 1:1020 S MIAMI BLVD
Mailing Address - Street 2:STE. 106
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-5417
Mailing Address - Country:US
Mailing Address - Phone:919-596-9479
Mailing Address - Fax:919-957-0099
Practice Address - Street 1:1020 S MIAMI BLVD
Practice Address - Street 2:STE. 106
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-5417
Practice Address - Country:US
Practice Address - Phone:919-596-9479
Practice Address - Fax:919-957-0099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-16
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC4398251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6602281Medicaid