Provider Demographics
NPI:1730311127
Name:PHILSON'S HOME HEALTH
Entity Type:Organization
Organization Name:PHILSON'S HOME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CLARENCE
Authorized Official - Middle Name:RENAULT
Authorized Official - Last Name:PHILSON
Authorized Official - Suffix:I
Authorized Official - Credentials:
Authorized Official - Phone:252-520-9353
Mailing Address - Street 1:1005 BULLARD CT
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-6855
Mailing Address - Country:US
Mailing Address - Phone:919-877-8155
Mailing Address - Fax:919-877-8154
Practice Address - Street 1:1005 BULLARD CT
Practice Address - Street 2:SUITE 100
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-6855
Practice Address - Country:US
Practice Address - Phone:919-877-8155
Practice Address - Fax:919-877-8154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-18
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3768251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCHC3768Medicaid