Provider Demographics
NPI:1891723979
Name:A GODLY HOME HEALTH CARE, INC.
Entity Type:Organization
Organization Name:A GODLY HOME HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEWART
Authorized Official - Middle Name:NOLAN
Authorized Official - Last Name:HAM
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:252-975-3580
Mailing Address - Street 1:3062 HIGHWAY 33 EAST
Mailing Address - Street 2:
Mailing Address - City:CHOCOWINITY
Mailing Address - State:NC
Mailing Address - Zip Code:27817-8142
Mailing Address - Country:US
Mailing Address - Phone:252-975-3580
Mailing Address - Fax:252-975-6523
Practice Address - Street 1:3062 HIGHWAY 33 EAST
Practice Address - Street 2:
Practice Address - City:CHOCOWINITY
Practice Address - State:NC
Practice Address - Zip Code:27817-8142
Practice Address - Country:US
Practice Address - Phone:252-975-3580
Practice Address - Fax:252-975-6523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
163W00000X, 376K00000X
NCHC-3100374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
Not Answered374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
Not Answered376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408745Medicaid
NC6601328Medicaid