Provider Demographics
NPI:1730320086
Name:PELHAM HOME HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:PELHAM HOME HEALTH SERVICES, INC.
Other - Org Name:PELHAM HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MILDRED
Authorized Official - Middle Name:C
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:RNC,BSN
Authorized Official - Phone:910-630-6757
Mailing Address - Street 1:PO BOX 9754
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-9091
Mailing Address - Country:US
Mailing Address - Phone:910-630-6757
Mailing Address - Fax:910-884-9806
Practice Address - Street 1:2501 FAYETTEVILLE ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27332-5910
Practice Address - Country:US
Practice Address - Phone:919-718-0388
Practice Address - Fax:919-718-0389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-17
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC2838251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6601211Medicaid