Provider Demographics
NPI:1841432804
Name:G W HOME HEALTH AGENCY INC
Entity Type:Organization
Organization Name:G W HOME HEALTH AGENCY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATIVE OFFICE MANGER/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GORHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-814-3199
Mailing Address - Street 1:313 CLIFTON ST
Mailing Address - Street 2:SUITE A1
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-5008
Mailing Address - Country:US
Mailing Address - Phone:252-814-3199
Mailing Address - Fax:252-756-1694
Practice Address - Street 1:313 CLIFTON STREET
Practice Address - Street 2:SUITE A1
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5008
Practice Address - Country:US
Practice Address - Phone:252-814-3199
Practice Address - Fax:252-756-1694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-06
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3747P1801X251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC=========OtherEIN